Chronic or acute back or neck pain can become debilitating. The primary goal of treatment is to minimize pain in order to improve the patient’s quality of life. As often as possible, physicians seek to achieve this goal without resorting to surgery. Epidural steroid injections provide us the opportunity to do that.
What Are Epidural Steroid Injections?
Leg pain and arm pain can originate in the spine. Pain and other symptoms that radiate down an upper or lower extremity may relate to inflammation in a segment of the spine. Epidural steroid injections are a common form of treatment to reduce this inflammation. Treatment involves the insertion of a thin needle into the affected spinal segment. Along with steroid medication, the injection may contain a local anesthetic that provides immediate pain relief. After receiving their steroid injection, many patients are able to resume a better quality of movement within 24 to 48 hours
Candidates For Epidural Steroid Injections
The fat-filled area around the spinal cord is called the epidural space. This space may become narrow as a result of inflammation. Causes of inflammation include misaligned spinal joints or “slipped vertebrae,” herniated spinal disc, bone spurs, a cyst in the spinal joint, or thickening of the spinal ligaments. Doctors perform a thorough medical history, consultation, and physical examination to determine the beneficial effects epidural steroid injections can have on a person’s pain. Patients understand that injections are administered as a form of pain relief and do not correct the underlying condition that is causing pain.
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Where Can Injections Be Made On The Body?
Epidural injections are, by definition, administered into the spine. However, there are unique methods with which treatment may occur.
- Interlaminar epidural injections
- Caudal epidural injections
- Transforaminal epidural injection
Interlaminar Epidural Injections
Interlaminar epidural injections involve the placement of a needle into the back of the epidural spinal space. This technique spreads the anti-inflammatory steroid across a wider area.
Caudal Epidural Steroid Injection
Caudal epidural injections involve the insertion of the small needle into the sacral hiatus, which is positioned just above the tailbone. This approach introduces medication into the very bottom of the epidural space. Like Interlaminar injections, caudal epidural injections can spread the necessary steroid across several spinal segments.
Transforaminal Epidural Injection
Transforaminal epidural injection may also be referred to as a nerve block. This injection technique administers steroid medication into the “nerve sleeve” of the affected spinal segment. The medication travels along the sleeve in greater concentration, alleviating localized pain.
This injection is performed to relieve neck, shoulder and arm pain related to compression of a nerve root in
the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.
Benefits Of Steroid Injections For Pain Management
The primary benefit of steroid injections is lasting pain relief. Additionally, patients appreciate that treatment is convenient, taking approximately 30 minutes, and that local anesthetic makes the treatment easily tolerable. Finally, steroid injections are complementary to a broader scope of treatment that also involves physical therapy and other modalities.
How Steroid Injections Help With Pain
Epidural steroid injections deliver steroid medication directly into the space around the spinal cord. In addition, an anesthetic such as Lidocaine may also be included in the injection. Finally, the injection may also contain saline. Each of these components has a specific effect on the nerve roots that are causing pain.
The steroid ingredient in the injection acts as an anti-inflammatory agent. The anesthetic can provide prompt and lasting pain relief by decreasing the sensations in the nerves. Saline is a non-therapeutic salt-water that flushes the epidural space of mediators that allow inflammation to persist.
How Long Do Steroid Injections Last?
Most people can obtain satisfactory pain relief with epidural steroid injections. By reducing inflammation in the spinal space, this method of treatment can interrupt the pain cycle for several months at a time. Although the body may learn to compensate for the underlying injury and therapeutic exercise may improve body mechanics, some degree of pain may return after treatment. Epidural steroid injections can safely be repeated periodically to maintain comfort and quality of life.
Do Epidural Steroid Injections Hurt?
Our standard of patient-centered care guides us to prioritize comfort in all treatments. Epidural steroid injections may follow a small injection of numbing medication to allow a patient to receive treatment comfortably. The use of a local anesthetic provides immediate comfort that wears off gradually throughout the day, thereby reducing any discomfort that may occur after the epidural.
Are There Any Side Effects To Steroid Injections?
Epidural steroid injections have been a common form of treatment for decades. Many people have safely received these spinal injections without adverse reaction. Risks of complications are very low due to the use of fluoroscopic guidance during needle insertion. Potential risks include infection, nerve damage, bleeding, allergic reaction to the medication and, very rarely, paralysis.
Most patients tolerate epidural steroid injections without side effects. Although uncommon, some patients notice that their usual pain feels more intense for several days after treatment. Side effects may also include what is called a “steroid flush,” a sensation of warmth coupled with redness in the chest and face. Injections may also be followed by changes in menstruation, difficulty sleeping, temporary water retention, and anxiety. If side effects do occur, they typically disappear in a few days.
How can I prepare for my steroid injections?
If you take a blood-thinning medication, there is a risk that you could experience excessive bleeding from your epidural injection. It is important to talk with your provider about medications and supplements you are taking so proper steps can be taken to discontinue use of non-essential products. This decision should be made by a primary physician or, if the medication is prescribed, by the prescribing doctor. Examples of medications that can create a bleeding risk include Lovenox, Plavix, and Coumadin, among others.
Aside from avoiding certain medications and supplements if necessary, you should not eat or drink anything in the 8 hours before your injection. If your treatment will involve sedation, you must have someone accompany you to your appointment who can drive you home afterward.
What conditions can Epidural Steroids treat?
Epidural steroid injections have been used for many decades to treat chronic back and neck pain. These conditions may stem from a number of spinal problems, including spinal stenosis, herniated discs, and recurring pain after a spinal procedure. These injections have also been helpful in minimizing post-herpetic neuralgia in patients who have had shingles, and in the management of spondylolisthesis.
How long does the Steroid remain in your system?
This can vary from one person to another. Generally, steroid injection results last 3 months or longer. The effects of the injection wear off as the body naturally breaks down and metabolizes the steroid. It is safe for a patient to receive additional injections a few times a year if needed.
Is there a difference between an Epidural Steroid and other steroids?
Epidural steroid injections are a technique of delivering a corticosteroid medication into the epidural space of the spine where nerve inflammation originates. Corticosteroid medications mimic the effects of natural cortisone and hydrocortisone, both of which soothe systemic inflammation in the body. The corticosteroids that are used in the clinical setting are different than the steroids that some athletes use.
What can I expect from my results?
Pain may feel noticeably reduced during the first few hours after the epidural injection. This is more so because of the local anesthetic that is used than the effects of the steroid itself. Patients are encouraged to take it easy for the remainder of the day of their injection. They can usually return to work the following day without any lingering discomfort from the injection. Generally, the steroid begins to work sometime during the first week after the injection.
How long do the injections usually last?
The effects of an epidural steroid injection typically lasts about three months. This can be a sufficient amount of time for the original injury or source of pain to heal, so some patients experience permanent or long-term relief from just one treatment. In other situations where pain is chronic, follow-up injections may need to be scheduled.