Three Ways Epidural Injections Are Different Now for Pain Management

spinal stenosis

Epidural steroid injections for pain management are one of the most common and most effective procedures performed to alleviate pain. They are utilized for relief of sciatica due to a disc herniation causing a pinched nerve, they're useful for spinal stenosis, and can be great in the neck as well to alleviate symptoms of radiculopathy.

How are epidural steroid injections different today than they were 20 years ago? One thing that has not changed is their effectiveness. Multiple studies have confirmed that epidural steroid injections for sciatica and radiculopathy maintain at least a 75% average effectiveness rate for pain relief. It may be one injection that does the trick so to speak, or maybe a full series of 3 injections. But the results from epidural started injections are sometimes as high in studies as 90%, which is similar to that seen with lumbar surgery for a disc herniation (without the risks).

Here are 3 ways the procedures for pain management have changed.

1. The standard of care with epidural steroid injections has changed with regards to how they are performed. The use of a real-time x-ray machine known as fluoroscopy has altered the way the epidural injections are performed. A landmark study over a decade ago showed that without the usage of fluoroscopy, injections into the epidural space missed approximately 30 to 40% of the time. If the patient is willing to undergo the procedure and except the small but real risks associated with it, they should be sure of getting the most accurate injection possible. Fluoroscopy allows the most accurate injection possible, so it has become pretty much the standard of care for doing them.

2. Transforaminal epidural steroid injections have become much more popular. Over the last 10 to 15 years, transforaminal injections for relieving pain have increased in popularity due to the fact that the steroid is placed closer to the area of the nerve root impingement. The theory is that with the steroid bathing the area of the pinched nerve and relieving inflammation, the amount of pain relief achieved with a transforaminal injection can be better. Therefore, the procedures popularity has increased exponentially over the older version, which is known as an intralaminar injection.

3. The newest epidural steroid injections have been using steroid material that has less particulate matter than previously. There have been some complications noted with the steroid substances that have heavy amounts of large particulate matter. Therefore a lot of pain doctors are switching to steroid medications that have less amounts present. It's a little bit of a catch 22. You need to particulate matter to have the medication stay around for a while to achieve its anti-inflammatory effect. But you don't want too much or too large of a particulate matter that can cause potential complications. So epidural steroid injections are headed towards a happy medium with just enough particulate matter to keep the medication there for optimal effect with the least amount of complications.