Back pain can have a variety of causes. It may be triggered by injury, poor posture, herniated discs, and other conditions.
One common cause of back pain is a nerve that has become sensitized or compressed in the epidural area. This can result from a herniated disc, a narrowed nerve canal, or a bone spur. A damaged nerve can lead to inflammation, causing pain, numbness, or tingling. To treat this inflammation, a pain specialist administers a steroid injection into the epidural space, one of the methods used to alleviate lower back pain.
What is an Epidural Steroid Injection?
This procedure involves injecting a mixture of anti-inflammatory steroids and local anesthetics into the epidural space. This space is located between the yellow ligament of the spine and the dura mater, so the injection is not administered directly into the spinal cord.
The injected medication reduces inflammation, thus alleviating back pain.
What Happens During the Procedure?
Typically, an epidural steroid injection is given with the patient lying on their stomach (if it is done under X-ray guidance) or sitting (if it is done according to anatomical landmarks). Blood pressure and oxygen levels are monitored throughout the procedure. A pain doctor and assistant are always nearby, and if the patient feels uncomfortable or has any questions, a nearby medical specialist will be ready to help and reassure you at any time. In order to ensure the injection is very accurate, the procedure can be performed under X-ray guidance.
How Long Does the Procedure Take?
The injection itself takes only a few minutes, but the entire procedure is usually allotted an hour. During this time, the pain specialist discusses the procedure, medication effects, possible risks, and side effects with the patient. The clinic provides a gown for the patient to wear during the procedure, and time is given afterward for recovery.
What Concerns Do Patients Have?
Patients often ask if the procedure is painful. We reassure them that all procedures begin with administering a local anesthetic via a very fine needle. As the anesthetic takes effect, the patient may feel a slight pinch and warmth as the skin becomes numb. Once the anesthetic has taken effect, the epidural space is identified, and the steroid injection is given. If the patient is particularly anxious, the procedure can be performed under intravenous sedation, which helps the patient relax or even drift into light sleep. In this case, the patient may remember very little of the procedure. If sedation is planned, the patient should refrain from eating or drinking for at least 6 hours before the procedure and must be accompanied by someone, as they will be unable to drive afterward.
What to Expect After the Procedure?
Immediately after the epidural steroid injection, the patient may feel heaviness or slight numbness in their legs. Pain is usually significantly reduced immediately following the procedure due to the local anesthetic, and these sensations can last for a few hours. However, within a day or two, the pain may return, or there may be some soreness at the injection site. By the end of the week, the pain intensity should decrease.
For a few days after the procedure, pain specialists recommend avoiding strenuous physical activity. It’s best to rest and relax. Cold compresses can be applied to the injection site to help with recovery.
If there were no complications during the procedure, the pain specialist may allow the patient to return to work the same or the following day. However, it's essential to consult with the doctor who performed the procedure and follow their recommendations.
How Long Do the Medications Last?
The duration of the medication’s effects can vary by case. Steroids generally start working within 2-7 days after the procedure, and their effects can last from several weeks to several months.
Typically, to achieve the greatest effectiveness of treatment, it is recommended to repeat steroid injections. After each injection, the pain should gradually decrease. However, if only one procedure is enough to relieve the pain, repeated injections may not be necessary. In all cases, the pain doctor will answer any questions you may have and prescribe the most appropriate treatment plan.
What Are the Possible Side Effects?
Like any medical intervention, there may be side effects. Patients most commonly experience increased pain at the injection site, though this is usually short-lived and resolves within 1-2 days. In rare cases, the needle may puncture the dura mater, which contains cerebrospinal fluid, causing a headache. Other possible complications include infection, bleeding, or nerve damage. To avoid these risks, the procedure is performed under X-ray guidance to ensure the needle is precisely placed without damaging surrounding tissues.
Side effects from the steroids are typically very temporary and may include short-term increased sweating or flushing. If you have diabetes, consult the pain specialist about any necessary adjustments to your medications before and after the procedure.
At your initial consultation with the pain specialist, you can ask any questions you may have. Preparing a list of questions beforehand can ensure you receive the most comprehensive information.
When is an Epidural Steroid Injection Not Performed?
The pain specialist will not prescribe an epidural steroid injection without consulting the patient and thoroughly reviewing the clinical case. This injection is not recommended for patients who are allergic to any of the medications used in the procedure or have an infectious disease. Be sure to mention any medications you are taking, as adjustments may be needed, especially for blood-thinning medications.