Epidural Steroid Injections
What is a Epidural Steroid Injections?
An epidural steroid injection is an injection of prednisone-like medication into the epidural space near the spine to treat back pain caused by herniated discs or spinal stenosis. The procedure is similar to one used to treat a mother's labor pain before the birth of a baby. However in an epidural steroid injection a different kind of medication is used. The procedure usually takes about 5 to 15 minutes to perform and your visit will take approximately 30 to 45 minutes. During the injection you will be lying on your stomach.
A fluoroscopic x-ray unit will be used to guide the needle. Your back will
be washed with an iodine solution to clean the skin. A local anesthetic will
be injected into in the skin in order to minimize any pain that you might feel. A small
needle will then be used to give the injection. Most often the injections are
given in the low back near the level of your hips. The technique requires a
sensitive touch therefore it will be necessary for you to remain still for
a number of minutes during the injection. Following the injection, you will
rest for approximately 5 to 10 minutes before leaving.
How does am Epidural Steroid Injections reduce my pain?
Steroids are anti-inflammatory drugs. Many doctors believe that back pain caused by herniated discs or spinal stenosis involves a significant inflammatory component caused by chemical or mechanical irritation or an autoimmune response. Although oral steroids can be used to treat this, epidural steroids have the advantage of being delivered to the site of inflammation and therefore are more effective even though a smaller dose can be used. Using a small dose minimizes the side effects.
Epidural steroids may take up to a week to become effective. Many patients
will not notice a difference in their pain for at least two or three days.
In addition, the pain may start to return after a few days to a week following
the first injection. For this reason we may do two or three injections, spaced
ten to fourteen days apart. Most patients (approximately 60% to70%) will experience
a significant reduction in their pain following the series of injections. If
your pain returns, we can perform another series of three injections six months
after the first series or perform a single injection every four to six weeks.
Epidural steroid injections are only part of a comprehensive approach to
the treatment of back pain. Epidural steroid injections do not "cure" the
problem, but decrease the pain and inflammation and allow you to continue your
daily activities while your body repairs itself. Therefore you should continue
taking your pain medication as necessary, start a graded, mild exercise program,
which includes flexibility exercises, reevaluate and if necessary change poor
body mechanics and continue in physical therapy if it has been prescribed.
What are the side effects?
For most patients the injection is only mildly painful. You will be able to continue your normal activities following the injection. For a day or two following the injection, you may have some increase in your back pain. We will give you instructions on treating this. In addition, the steroid can cause side effects even though the dose is only the amount that your body makes in two to four days. These include facial flushing swelling, increased appetite and weight gain, changes in your moods and if you are diabetic, an increase in your blood sugar.
What are the possible risks?
Epidural steroid injections are generally very safe. We perform hundreds of these injections every year. Serious complications are rare, however we must inform you of the possibility of infection or spinal meningitis, injury to nerves resulting in numbness or weakness and rarely temporary loss of consciousness during the injection. In addition there is a small risk of headache following the injection.
What should I do before the appointment?
Wear comfortable, loose fitting clothes to the appointment. Please arrive fifteen minutes prior to your scheduled appointment time. Do not eat any solid food for six hours before the appointment. You may have water up to two hours before your appointment. This restriction is due to the very remote risk of vomiting during procedure. Please continue to take your regular pain medications and other medications on the day of the procedure. You may take them with a sip of water. If you are taking Coumadin, please let us know at least one week before your appointment so that we may tell you how many days before your appointment you are to take your last dose. Please arrange to have someone give you a ride home after your appointment, as there is a small risk of dizziness following the injection.