Any patient with complaints of back pain or sciatica (pain radiating down their leg) may be a candidate for epidural injections.
It is an injection of a long acting steroid (depomethylpredisone) into the spinal canal in the neck or low back.
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.
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.
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.
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.
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.
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.
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.
Contradictions to receiving this injection include: fever, injection, having a bleeding problem or being on blood thinners; or when you are pregnant.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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:
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.
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: