Epidural Steroid Injections: An Effective Solution for Back Pain
Oct 2009
Epidural steroid injections (ESIs) are minimally invasive shots used to relieve neck, arm, back and leg pain caused by inflamed spinal nerves, degenerative or herniated discs, and spinal stenosis, a narrowing of the spinal canal. The goal of the injection is pain relief; often the injection alone is sufficient to relieve pain and allow the patient to progress with a rehabilitative stretching, exercise and therapy program. ESIs can also help determine whether surgery might be beneficial for pain associated with a herniated or degenerative disc.
ESIs have been used since 1952 and are still an integral part of the non-surgical management of sciatica (nerve pain felt in the back and leg) and spinal pain. The use of fluoroscopy, a form of live X-ray used to assist in needle guidance, has made targeting the affected areas more precise and has improved patient outcomes.
Generally, ESIs are safe. However, as with any medical procedure, there are side effects and risks.
ESIs deliver medications directly to (or very near to) the source of pain generation in the epidural space—that area between the protective covering of the spinal cord and the vertebrae that communicates with the spinal nerves and intervertebral discs. Typically, the injection contains both a long-lasting corticosteroid (cortisone) and an anesthetic agent (i.e., lidocaine). The corticosteroid reduces inflammation and/or swelling. The majority of pain stems from inflammation, and ESIs can help control the inflammation of discs and spinal nerves while also “flushing out” inflammatory proteins and chemicals from the epidural space that may contribute to and exacerbate pain.
Generally, ESIs are safe. However, as with any medical procedure, there are side effects and risks. The most common side effect of an injection is temporary pain at the site of injection. Some patients may experience adverse reactions to the cortisone such as elevated blood sugar, weight gain, water retention and suppression of the body’s own natural cortisone production. Other risks include spinal puncture, possibly resulting in headaches, infection, bleeding and nerve or spinal cord injury. This risk is very low, however, when the injection is administered by a physician who has specific training in these procedures and who uses fluoroscopy to produce real-time images of the patient’s body during the injection.
The extent of pain relief an ESI offers varies from patient to patient—lasting from days to years—and depends on a number of factors, including the body’s response to the steroid medication, the level of degeneration and the amount of inflammation. Typically, no more than three injections are given to one patient in a six-month period, although more may be given if the patient experiences no adverse side effects from the cortisone.