Epidural Steroid Injections: What You Need to Know
Back pain can seem unbearable and inescapable. The discomfort can be severe enough to hinder healing and rehabilitation. With epidural steroid injection, this pain can be soothed right at the source to give the surrounding tissues time to heal properly or to allow a patient to continue recovering with physical therapy.
Back pain from disease or injury is caused by inflamed spinal nerves surrounding the affected area. Epidural steroid injection applies medicine directly into this area. This is meant to calm the inflamed cells and shut down pain.
This procedure comes in various forms, depending on the injection method. For instance, interlaminar means that the injection site is located between two spine vertebrae, whereas the transforaminal method is administered diagonally alongside the side of the nerve sleeve. The caudal injection is positioned carefully through the wedge shape of the sacrum vertebra located at the bottom of the spine.
Typically, an epidural steroid injection will be considered for patients who have tried medication and physical therapy, but want to avoid an invasive and complicated surgery. It can be used to soothe pain from conditions like spinal stenosis, herniated discs, or degenerative disc diseases.
The goal of epidural steroid injections in the immediate term is not to cure these problems, but to relieve the pain. Without this discomfort, the trauma to the nerves can begin to repair unimpeded and a patient can continue with the physical therapy necessary in order to regain normal, healthy movement. In the end result, the injection reduces pressure, swelling and irritation around the nerve root, giving the body time to heal itself.
An epidural steroid injection is significantly less invasive and typically more cost-effective than major surgery. The recovery time is also minimal as a patient is usually released within half an hour after the surgery with nothing but a band aid to show for their experience.
Although it may take a few days for the steroids to take full effect, many patients have experienced relief that can last a relatively long time. The relief from this pain can also help get previously suffering patients active and working towards healing again, which may eliminate the cause of the pain altogether.
The site of the needle injection is an important aspect to the type of pain a patient is experiencing. For pain in the neck, shoulders, and arms, a cervical epidural injection is performed in the sack of nerve roots behind the topmost vertebra. For upper back, rib, or chest pain, the needle is inserted into the thoracic area or middle of the spine. Lower back, hip, glute, or leg pain requires a lumbar spine injection in the lower zone of the back.
In an epidural steroid injection, the patient is asked to lie face down on a pillow to help give their back a natural curve. This widens the spaces between the vertebrae, providing an optimal amount of space for the needle. The area of injection is then sterilized and given a local anesthetic to numb the surrounding skin and tissue. Intravenous sedation is an option for patient comfort.
With the help of a fluoroscopic X-ray, which shows real-time moving imagery of beneath the skin, the doctor inserts the needle, guides the needle to the precise target point under direct fluoroscopic visualization, and injects a contrast dye to make sure the positioning is correct. A local anesthetic and corticosteroid mixture is then injected to the targeted region. After the needle is removed, the patient is given a small bandage and is free to leave shortly after the procedure is complete. The injections are typically performed in series, and a second injection can amplify the results of the first, approximately 2 weeks later. Up to three epidural steroid injections may be performed in series for optimal results, although all three injections are not required for complete resolution of pain.
What are the drugs used?
The injection cocktail is a combination of local anesthetic and corticosteroid. The anesthetic provides immediate relief to the pained area while the steroids, typically Dexamethasone, work as an anti-inflammatory to soothe the irritated nerves. The contrast dye used to guide the doctor is typically made of a nonionic radio contrast agent. This agent has been proven to show up starkly under the fluoroscopic X-ray to give the doctor the best visibility.
After injection, it may take the corticosteroid up to three to seven days to fully take effect. In this time, after the anesthetic wears off, pain may remain unchanged or it may increase. The site of the injection may be sore or tender. This pain can be relieved with ice packs to help reduce the residual inflammation.
As this procedure is minimally invasive, the pain during the injection is typically minimal. Local anesthesia is applied to numb the area to make sure the procedure is as painless as possible, but a sensation of pressure or even reproduction or amplification of the pain can be felt during the procedure. This is only temporary, and resolves after the procedure. If this is concerning, IV sedation is a safe and effective option to make the procedure relatively painless.
If more than one injection is required, there is a wait time of at least two weeks before the next one can be applied. This is because two weeks is the amount of time it takes for the injected solution to completely cleanse from the body. The timing after this two-week window does not hinder the effectiveness of the next injection. However, after three injections, it is typical to wait at least six months before considering another injection.
With epidural steroid injections, it can be possible to alleviate pain and get back to normal recovery routines. The physicians at Pinnacle Pain and Spine take the time to find what will work best for you, whether that means an epidural steroid injection or one of the various other treatments offered – so schedule a consultation today, and get back to living well again.