1. Who should get this injection?
Any patient with complaints of back pain or sciatica (pain radiating down their leg) may be a candidate for epidural injections.
2. What is an epidural steroid injection?
It is an injection of a long acting steroid (depomethylpredisone) into the spinal canal in the neck or low back.
3. Why is steroid injected?
It is well known that at least part of the cause of the pain from a herniated disk is due to a severe inflammatory reaction. These medications help to reduce inflammation, shrink the disk hernation, and reduce any nerve irritation which may exist.
4. Where is the steroid injected?
The medication is injected in an area called the epidural space. This is the area between the nerves and disks. The medication therefore bathes these structures to help reduce what is causing the pain.
5. How many injections may a patient receive?
If the first treatment completely relieves the pain, then no further treatments may be required. Most patients receive between 2 or 3 treatments, every 2 weeks or so, until maximum benefit has been achieved.
6. How long an interval are there between injections?
There is always a follow visit after each treatment, to evaluate for benefit. If a second treatment is needed, it would be performed 2-3 weeks later. Performing subsequent treatments promotes additive benefit, and waiting too long (over a month) between treatments is not recommended.
7. How effective are epidural steroid injections?
A majority of patients will benefit from epidural steroid injections, and 50-60% will have long term relief. Unfortunately there is no way of predicting which patients will benefit from these treatments. At least two injections are recommended so that efficacy can be assessed. If necessary, other treatments can be performed as part of the diagnostic workup and which leads to treatment to achieve long term benefit.
8. Why not just take pills?
Epidural injections are more effective that taking oral medication. By placing a potent anti-inflammatory medication right where the problem is, the problem is treated more effectively. Oral NSAIDS (motrin- ibuprofin, advil, aleve etc) must be taken for long period of time. These can have negative effects on the stomach (gastritis, ulcers), kidneys, and liver. A few epidural injections, in this regard, are actually less risky.
9. Is it safe?
I have performed thousands of epidural injections in my 20+ years of practice without any serious adverse effects. Common effects include a possible temporary (1-2 day) increase in the pain, or at the injection site; A headache can occur on occasion, requiring rest and/or other therapies. Patients with insulin depend diabetes may experience an increase their blood sugar. There are however alternative medications that can be used for patients with poorly controlled diabetes.
10. When should I NOT get this injection?
Contradictions to receiving this injection include: fever, injection, having a bleeding problem or being on blood thinners; or when you are pregnant.
11. Where are these treatments performed?
Epidural injections may be performed in an ambulatory surgery center or outpatient area in a hospital. They are performed in an operating room, under sterile conditions. Fluoroscopy is used to direct the medication to the specific spinal level and side effected, to obtain the best result.
12. Will I have pain during the injection?
No, most (although not all) patients prefer to have anesthesia (intravenous sedation) during the treatment. Patients receive short acting medication that makes them sleepy for about 5-10 minutes. Shortly thereafter, you are brought to the recovery room, and are surprisingly wide awake in no time. You will receive something light to eat and drink in about 15 minutes after the procedure.
13. What specific conditions are treated with epidural injections?
Epidural injections have been used to treat many different types of conditions which may cause neck/back and extremity pain. These include cervical and lumbar disk herniations, degenerative disk disease, nerve impingement (ie. sciatica), spinal stenosis, and vertebral compression fractures.
How are Epidural Injections used as a tool for diagnosis?
An injection can help locate the source of pain. For example, a selective nerve root block or a selective epidural will block the pain of specific nerves. The effect is temporary, but if you feel relief, it may indicate the source of the pain. But if you feel no relief, it may mean that the source of the pain is either at another level of your spine, or in a different structure completely. These results help determine the most appropriate course of treatment to lead to long term benefit.
In what sites are the medicine injected?
The medicine may be is injected in a number of different areas depending upon what is believed to be the source of the pain, and depending upon the goals of the injection. Injections are diagnostic, therapeutic, or both. The injection can be done in the epidural space. This is the area within the spinal canal, where the intervertebral disks are and spinal cord exist. A specific nerve root may also be targeted to determine the nerve root level which is of the pain, your doctor Medicine is then injected directly onto that nerve root.
Learn more about your back anatomy. That way, you can understand how an injection can help relieve or locate your pain.
14. Vertebrae are the bones that stack up to form the spine.
15. Disks are “cushions” that provide padding between the vertebrae. A damaged disk can lead to inflammation and pain.
16. The spinal canal is a tunnel that’s formed within the stacked vertebrae. Nerves run through this canal. The nerves are wrapped by a thin layer of tissue.
17. A nerve root is the part of a nerve that leaves the spinal canal. Inflamed nerve roots can lead to back pain.
18. The sciatic nerve is a nerve that extends – down to the leg. When its nerve roots are inflamed, buttock and leg pain often result.
19. Are these the only treatments available?
No, there are many different types of treatments performed for various pain producing conditions in the neck and back. A comprehensive program can determine what is causing the condition, and state of the art therapies exist with the ultimate goal being to obtain permanent benefit.
The Epidural Procedure
Your Injection Procedure
A lumbar epidural injection is an outpatient procedure. It’s often done in a hospital or an outpatient surgery center. Before your injection, your doctor will ask you questions about your health. He or she also will discuss how you need to prepare.
Your doctor may ask you to prepare by doing the following:
- Provide a list of all medicines you take, including aspirin and anti-inflammatories. (You may need to stop taking some of them before the injection.)
- Don’t eat 8 hours before check-in, or drink anything 4 hours before.
- Arrange for a responsible adult to drive you home afterward.
- Bring any requested x-ray, CT, or MRI images, on the day of the procedure.
Can I drive myself home?
If you are receiving anesthesia, then no you cannot drive the day of the injection. However, if you have decided not to receive any sedation, then you may be able to drive yourself home.
How do I prepare?
You cannot eat for 8 hours prior to the procedure. If it is being done in the morning, that means no food after midnight. If it is being done in the afternoon, then a light breakfast at 8am is OK. You should stop aspirin and any other blood thinners for 5 days before the treatment. It is OK to take blood pressure or other medication with a small sip of water in the morning. If you take oral diabetes medication, bring it with you to take after the procedure.
You’ll be asked to fill out and sign some forms when you check in. These can include surveys about your pain. Your doctor also may give you a brief physical exam. Finally, you may receive an IV (intravenous) line to give you fluids and medicine.
During the Procedure
The injection takes just a few minutes. But extra time is needed to get ready. You may be given medicine before the injection to help you relax.
- Monitoring devices may be attached to your chest or side. These devices measure your heart rate, breathing, and blood pressure.
- You lie on your stomach or side, depending on where the injection will be given.
- Your back is cleaned and may be covered with sterile towels.
- Medicine is given to numb the skin near the injection site.
- If fluoroscopy (x-ray imaging) is to be used, a contrast “dye” may be injected into your back. This helps get a better image.
- A local anesthetic (for numbing), steroids (for reducing inflammation), or both are injected into the epidural space.
After the Procedure
You’ll spend up to an hour in a recovery area. Before going home, you may be asked to fill out another survey about your pain. You may notice some side effects. They should go away in the first few days. They can include:
- Briefly increased pain
- Trouble sleeping
When You Get Home
You don’t need to stay in bed when you get home. In fact, it’s best to walk around if you feel up to it. Just be careful about being too active. Even if you feel better right away, avoid activities that may strain your back. Keep in mind that some patients may feel increased pain at first. It usually goes away within a few days.
The First Few Days
An injection to reduce inflammation takes a day or two to work. There may even be more pain at first. An injection to help locate the source of pain may give only brief pain relief. Later, you’ll feel the same as you did before the injection. Follow up on treatment with your doctor. Whether you were injected for pain relief or diagnosis, these tips will help you recover:
- Take walks when you feel up to it.
- Rest if needed, but get up and move around after sitting for half an hour.
- Don’t exercise vigorously.
- Don’t drive the day of the procedure or until your doctor says it’s OK.
- Return to work or other activities when your doctor says you’re ready.
Improving Strength and Motion
Exercises and good body mechanics (how you move) may help keep pain from returning or worsening. The exercises below help build strength and flexibility. Your doctor may suggest other exercises for you to try. Call your doctor if you feel any new or lasting pain after exercising.
- Lie on your back with your knees bent and your feet flat.
- Tighten your stomach and buttocks, and gently press your low back into the bed. This tilts your pelvis.
- Hold for 5 seconds. Repeat 10 times. Do this twice a day.
- Lie on your back with your feet flat, your knees bent, and your arms crossed over your chest.
- Slowly raise your head and shoulders off the floor.
- Hold for 5 seconds. Repeat 10 times. Do this twice a day.
No matter how strong your back is, lift safely to prevent injuries: Make it a rule to follow these steps:
- Stand close to the object:
- Bend at the hips and knees: Keep your ears, shoulders, and hips in line.
- Hold the object close to your body.
- Press down with your feet and lift using your legs, not your back.
The Road to a Healthier Back
Whether your injection was for relieving pain or locating pain, you can take steps toward a healthier back. Talk to your doctor. Learn the best way to treat your pain. If it worsens, let your doctor know. But often, your back health is under your control. Exercise and good body mechanics help. Other choices in your life also can make a difference.
Lifestyle choices for a Healthier Back
- Quit Smoking: Nonsmokers are less likely than smokers to have back pain
- Eat Healthy: A low-fat, high-fiber diet can help control weight and improve back health.
- Manage Stress: Keeping stress in check can ease and may prevent back pain
- Stay Active: Physical activity, even walking, can help reduce pain and increase flexibility and strength