Epidural Steroid Injection is a medical procedure primarily performed to reduce pain in patients suffering from the one or more of the following:
- Spinal stenosis (narrowing)
- Spinal degeneration
- Disc herniation
- Disc protrusion
Basically, this reduces the pain and inflammation related to nerve root compression. Illnesses like bone spurs, spinal stenosis and herniated discs can compress the nerve roots. Ultimately, inflammation occurs, and it leads to numbness, weakness, tingling and pain in nerves, this condition is commonly known as radiculopathy. The central role of the epidural steroid injection is to reduce the inflammation in spinal nerves.
In layman’s terms — back pain sourced from any disease or injury is mainly the result of inflamed nerves surrounding the affected body part. Epidural steroid injections are used to inject the medicine directly into the affected area. It helps to calm down the pain and lessen the inflammation.
Nowadays, you can avail this process in various types. The form of the procedure depends on how you inject the medicine. For example, if the injection is diagonally administered alongside the nerve sleeve, it is the transforaminal method.
If it is being injected at the bottom of the spine, through the sacrum vertebrae’s wedge shape, it is a caudal injection method. And if the area between two spinal vertebrae is the injection site, this method is interlaminar.
What’s more, cervical epidural injections are given on the neck, thoracic epidural injections are given in the mid-back, and lumbar epidural injections are given in the lower back.
Who Is It Suitable For?
Generally, the procedure or epidural steroid injections are ideal for chronic pain patients who have already tried physical therapy and medication, but they do not want to undergo surgery.
If patients are looking for a relief from herniated discs, spinal stenosis, or other degenerative disc diseases, epidural injections are great.
You have to understand that these injections do not cure the disease but calm the pain and offer much-needed relief. With them, patients can continue their ongoing therapies with ease to regain their healthy and everyday movements. Most importantly, they provide valuable time for the body to recover by reducing irritation, swelling, and pressure on the nerve root.
How Are The Patients Prepared For Epidural Steroid Injections?
Doctors give specific instructions to the patients before coming for the procedure. In most cases, doctors advise patients to have a small meal a couple of hours before the injection. Unless the patient is not mainly on anti-inflammatory or blood thinners medication, they can continue with their current medicines.
Inform your pain doctor about all the drugs you are on before the procedure. This helps the doctors decide if you should continue those medicines or not.
When the patient arrives at the hospital or clinic, doctors place intravenous (IV) to prepare him for the epidural steroid injections. If needed, doctors may also give medication to relax the patient during the procedure. The patient is then placed over the x-ray machine to pinpoint the exact location in the back. The x-ray obtains a correct level of injection. Doctors then clean the skin and inject the medicine to numb the affected area.
What Are The Drugs Used In The Injection?
The mixture in the injection is basically a combo of local anesthetic and corticosteroid. The steroid used here is mostly Dexamethasone. It soothes the irritating nerves in the affected area due to its anti-inflammatory properties. On the other hand, the local anesthetic is used for quick relief from pain.
This procedure also includes a contrast dye which is primarily used to guide the doctor. A nonionic radiocontrast agent is the main content of this dye. This agent helps the doctor with the best visibility as it shows up starkly under the fluoroscopic X-ray.
What Happens During The Epidural Steroid Injections?
The doctors insert the needle once the affected area is numb and adequately prepared. The injection goes through the skin and directed towards the spine.
Doctors may inject a minimal amount of dye to verify if the needle is on the right spot. An x-ray is used to locate this. Once the location is confirmed, the local anesthetic and steroid cocktail is inserted through the needle in the affected area. In the end, they get the needle out and apply the band-aid over the injection site.
What Are The Benefits Of Epidural Steroid Injections?
Surgeries are not so favorable for all. Epidural steroid injections are the best alternative for that. It is less invasive and more cost-effective than surgeries.
Plus, the recovery time in this procedure is significantly less. Patients are often released within half an hour with just a band-aid on the injection site.
While it is true that steroids may take a couple of days to work on the pain areas, many patients have reported instant relief that lasted for several days.
There’s another benefit of this procedure — the steroid injections offer comfort to previously suffering patients that help them heal in the absence of pain. This promotes recovery and may also eliminate the root cause of the pain.
What Happens After The Procedure Of Epidural Steroid Injections?
In most of the cases, patients are moved to the recovery room once the injection is given. Doctors monitor them for about an hour. If all the readings are in place, doctors allow the patients to leave. However, the patients should plan a day’s rest once they reach home. The best part is — they can eat or drink as per their choice. There are no such food restrictions.
Patients should not operate any machinery or drive any vehicle for at least 12 hours from the procedure.
Some patients may feel numbness, drowsiness, tingling, or weakness in the legs for the remainder of the day; however, it is entirely normal. This will gradually go away as the day passes.
What Are The Injection Sites For Different Types Of Pain?
This most significant factor used to decide the needle site for the injection is the type of pain the patient is going through.
If the patient is experiencing pain in the chest, rib, or upper back, the injection is given in the middle part of the spine or into the thoracic area. If the affected area is one of the neck, arms or shoulders, the needle is injected in the nerve roots’ sack.
These roots are located behind the topmost vertebra. As long as the pain in legs, hips, glute or lower back is concerned, the lumbar spine procedure is done, and the needle is inserted in the lower back area.
When Should A Patient Call The Doctor After The Epidural Steroid Procedure?
If you develop any of the below-mentioned symptoms after the epidural steroid procedure, seek medical advice from your doctor as soon as possible:
- Difficulty in breathing
- Improved pain levels
- Skin reaction
- Severe headache
- Dizziness
- Prolonged numbness or tingling
What Are The Side Effects Of Epidural Steroid Injections?
The corticosteroid used in the injection may take up to 7 days to work on the patient. During this time, the anesthetic may wear off, and the patient may experience the same or increased pain levels. Plus, the injection site may get tender or sore. Patients can use ice packs to prevent residual inflammation in such scenarios.
Generally, the epidural steroid injections are very safe, but there is a chance of some rare potential difficulties. The most common and the most prominent side effect is that the needed can cause a hole in dura if inserted too deep. Dura is the tissue that cushions the nerve roots and spinal cord. A hole in the dura can take the spinal fluid out in the body and result in headache. A simple blood patch or rest can treat this headache.
In rare cases, a patient may experience allergic reactions due to the medications involved in this procedure. This can lead to swelling, drop in blood pressure, wheezing, or itching.
Neurologic injury is also a rare consequence if the needle touches the nerve root or spinal cord. The most common symptoms of this are tingling in the extremities and a feeling of numbness.
Do Patients Feel Pain From Epidural Steroid Injections?
Due to this procedure’s minimally invasive nature, the patients do not experience significant pain during this. Doctors use local anesthesia to numb the affected area. This ensures the painless procedure; however, patients may experience amplification, reproduction, or pressure during the process.
The good news — that’s only temporary and goes away once the procedure is done. If this concerns any patient, doctors may use IV sedation to make the process even more painless.
Is It Necessary To Follow-Up With The Doctor After The Procedure?
Follow-up appointments are recommended in most of the cases. Doctors typically ask patients to schedule their visit between second to the sixth week after the procedure.
Such follow-ups’ primary aim is to monitor how the patient has responded to the injection and are there any other symptoms of nerve compression or any other pain.
Doctors may consider repeating the injection for the patients with persistent pain symptoms or those who have returned after a certain period. Most of the leading physicians do not advise more than 3-4 injections in a year.
How Long Can Patients Go Between Two Treatments?
For the patients who need more than one injection, at least two weeks of gap is suggested between the two consecutive procedures because it is the ideal time for the injected cocktail to be entirely cleansed from the body.
The timings post these two weeks do not hamper the effectiveness of the next procedure. Note that most of the doctors recommend at least six months of gap after the third injection.
Does The Patient Have To Lie On Stomach For A Long Time During And After The Procedure?
This procedure does not take more than 10 to 20 minutes to complete. You have to lie prone to get the right x-ray fluoroscopy. Once the procedure is done, you can walk, sit, stand as usual just after a short period of body inspection.
Final Thoughts
This minimally invasive pain treating procedure is excellent for relief from leg, neck, arm, and back pain sourced from inflamed spinal nerves.
The pain relief offered by the epidural steroid injections may last for weeks or even years. It is the ultimate option if you do not want to undergo any surgery. With this procedure from a reputable pain doctor, you save yourself from costly surgeries, medications and stress.
Even if you have existing pain issues, this procedure offers relaxation so that you can resume your day-to-day activities and physical therapy treatments.
