Frequently Asked Questions About Lumbar Pain Management Injections

spinal stenosis

What is an epidural steroid injection?

An epidural injection for pain management is a procedure where a long-lasting steroid is administered into the epidural space. The epidural space is the area around the spinal cord, or to be an atomically exact it's the area around the remnant of the spinal cord where nerve roots come off at every level.

What is the purpose of an epidural injection?

With an epidural steroid injection, the purpose is to decrease swelling and inflammation around nerves roots in the epidural space. These nerve roots are typically being either compressed by a piece of disc herniation, or potentially being compressed from arthritis and bone or soft tissue overgrowth with spinal stenosis. Additionally, there are situations where a nerve root is being inflamed from chemicals produced when a disk has a tear in it from degenerative disc disease.

How long does an epidural injection take?

The actual injection typically takes less than 15 min.

What is being injected with an epidural steroid injection?

When an epidural steroid injection is performed, typically there is some numbing medicine that is included which is either lidocaine or Marcaine. The particular steroid that is included may be either triamcinolone, methylprednisolone, or there are a few others.

Does an epidural start injection hurt?

The epidural injection does involve sticking a needle through the skin around the area of the spinal canal. So there is some amount of discomfort. Fortunately, however, the skin and deeper tissues are numbed up with a medication such as lidocaine prior to inserting the larger needle. Sometimes patients also receive IV sedation, which makes the procedure easy to tolerate.

Will I be under anesthesia for the procedure?

Patients do not require general anesthesia for an epidural steroid injection. Often times patients do not even require IV sedation for the procedure, and it is able to be done simply with local numbing medicine. However, patients may receive IV sedation if they have anxiety or stress or simply desire it.

How is the injection done?

There are numerous methods of patient positioning for epidural steroid injections. Patients may lie flat on his or her stomach, the patient may be sitting up, or on his or her side. A lot of this depends on the clinicians experience. The area for the injection is sterilized and the patient is typically monitored with vital signs during and after the procedure. After the procedure, the patient is typically placed into a wheelchair and placed in the recovery area until ready to go home.

What should I expect after an epidural injection?

Right after the epidural injection, patients may feel that their legs are slightly heavy and may have some numbness from the medication. The pain may be dramatically relieved or lessened, which is due to the local numbing medicine injected. This will probably wear off after a few hours at which time the pain will probably return and you may have a sore back for a day or so then the steroid medication will hopefully start to kick in and the pain relief will result.

What should I do after the epidural procedure?

Patients should arrange for a ride home after the injection. Especially if they've had IV sedation for the injection. Patients are typically advised to take it easy for a day or so after the injection. There should not be any significant activity restrictions as tolerated unless it was a special type of situation.

Can I go back to work the next day?

Typically yes patients will be able to go back to work the next day after the procedure unless it was some sort of a complication.

How long will the medication last for my pain?

Typically the immediate pain relief is from the local numbing medicine and this will unfortunate wear off within a few hours. The steroid medication should start working after about 3 to 5 days and its effects may last for weeks to months.

How many injections are necessary?

It is debatable the number of epidural started injections necessary for relief of pain. If the 1st injection does not give complete relief to a patient's symptoms, most pain doctors will perform a 2nd injection and maybe even a 3rd one after that. If the injection takes care of the pain completely, there really is no reason to add a 2nd injection unless it starts to wear off.

Can I have more than 3 injections with epidural steroids?

Most pain management doctors will only perform a series of 3 injections every 3 to 6 months. This is due to the additive effect of having steroid medications in the body and concern over systemic side effects.

How effective are epidural steroid injections?

There is a lot of literature that has looked at this and the results are all over the board. Patients who have sciatica respond better to the injections than those who simply have low back pain. Most results show that epidural injections for sciatica work well between 65 to 80% of the time.

What are the risks associated with epidural started injections?

The risk profile for in epidural injections is low. However there is a small risk of infection, spinal puncture bleeding, nerve damage, symptom worsening, and pain. There are also some risks of the cortison itself including potential weight gain, potential increased blood sugar, water retention, and suppression of the body's own cortisone production.