Epidural Steroid Injection

Back pain, regardless if it’s short-term or chronic, can cause you to not only experience  a reduction in your quality of life, but also have to deal with the feeling of pain itself. Additionally, many instances of back pain actually spread or are felt in other parts of the body, making the pain difficult to bear. At California Pain Consultants, in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas, we believe that no person should have to undergo any feeling of pain, and offer pain management solutions to provide relief as comfortably and as quickly as possible. For those suffering from back back, epidural steroid injections could be a great solution. 

What is an Epidural Steroid Injection? 

An epidural steroid injection, or ESI, is a safe and relatively pain-free pain management tool for treating chronic pain, specifically in the back. To break it down further, the epidural space is the space around the spinal nerves in the spine. Providers target this space as the best location for treating pain caused by irritation and inflammation of spinal nerve roots. The medication itself, which is a steroid or corticosteroid, is a mixture of a pain reliever and an anti-inflammatory medication, which is administered through a syringe. The injected steroid coats the irritated nerve or nerves that are thought to be causing the pain, and reduces the swelling and pressure on the nerves. This provides the nerves with the required space for them to heal. The goal of the injection is to both reduce the inflammation affecting the targeted nerves, as well as to stop the pain signals from being sent to the brain. 

Not only does the injection help to immediately reduce pain in the back where the nerves were targeted, it can also help relieve neck, arm, back and leg pain caused by inflamed spinal nerves due to certain conditions or injuries. This is because epidural steroid injections are a great way to treat radicular pain, which refers to pain felt due to an irritated, weakened or affected nerve root. Since nerves travel through the spinal column to the rest of the body, radicular (or “root”) pain can be felt in the lower back down the legs (lumbar radiculopathy) or from the neck down the arms (cervical radiculopathy). This makes epidural steroid injections a great pain-relieving option for treating nerve compression in both the neck and lower back, providing pain relief for a myriad of damaged nerve locations.  

Patients who have received epidural steroid injections most often find immediate temporary pain relief, and possibly long-term or permanent pain relief. If pain relief is felt, patients can receive multiple injections, which has been shown to provide better management of chronic neck pain. 

How Successful are Epidural Steroid Injections?

Epidural steroid injections are so commonplace for treating chronic pain that they are considered a routine and relatively painless procedure. In fact, almost three out of four patients experienced immediate pain relief for neck pain and cervical radiculopathy. If pain relief isn’t completely remedied with the first injection, the injections are so safe that a second one can be administered in only two weeks and an optional third one after that, which should provide the intended amount of relief. 

Patients are able to benefit from the advancements of medical injections over the past several decades, and can expect not only better outcomes, but less risks and longer pain-free results. It’s worth noting that epidural steroid injections do not cure the cause of back pain. Patients will need to continue back exercises, therapies and other treatments to keep their chronic back pain at bay. 

What Does an Epidural Steroid Injection Treat?

ESI is one of the most common treatment options for managing chronic back pain. What makes it so attractive is that it’s minimally-invasive, provides immediate and extended relief, and affords patients the ability to take advantage of physical therapy and rehabilitative methods, pain-free. 

The most common conditions where pain management specialists might recommend ESIs are: 

• Herniated disc
• Degenerative disc disease
• Spinal stenosis
• Sciatica
• Spondylosis
• Failed Back Syndrome (FBS)
• Vertebral bone spurs
• Scoliosis

The main benefit of epidural steroid injections is that they provide immediate pain relief so that the patient can enjoy normal, everyday movements, as well as return to an active lifestyle. A secondary benefit, or use, of these injections is that many providers use them as a diagnostic tool. If the patient, who has yet to experience pain relief with medication, physical therapy or other non-surgical therapies, experiences pain relief, then the provider knows that this particular nerve area is the cause of pain and can then recommend any additional treatment he/she sees fit. The goal is always to help the patient experience a pain-free life by offering the most minimally-invasive and effective treatment options that have long-term results. 

What are the Different Types of Epidural Steroid Injections?

Epidural steroid injections are classified by their location, either cervical, thoracic or lumbar, as well as by the path the needle takes to get to the precise location in the epidural space, which is either interlaminar, transforaminal or caudal.

• Interlaminar Injection: administered in the midline of the back between the spinous processes (which are located between each vertebral column), the needle is directed between the two lamina (located at the roof or back of the spinal canal) of two vertebrae through the back of the vertebrae. The injection material spreads to both sides of the spine, and has great evidence for providing short-term pain relief of radicular pain due to disc herniation. 
• Transforaminal Injection: the injection is directed in the side of the vertebrae (opposed through the back) into the epidural space. This process requires two injections, as it can only treat one nerve at a time with a smaller dose of medication. However, this allows for more effective and target-specific treatment. This approach provides great short-term pain relief, as well as moderate evidence for the long-term benefit for the treatment of radicular pain. 
• Caudal Injection: due to the fact that the needle is delivered into the epidural space by the coccyx (tailbone), which is a large structure, more medication can be administered at one time, which effectively treats more nerves with one injection. This is most often the preferred approach for patients who have disrupted spinal anatomy as a result of previous spinal surgery. 
• It can also provide greater pain-relief for patients who suffer from radicular pain due to disc herniation, as well as chronic pain associated with Failed Back Syndrome and spinal stenosis. 

Most patients experience pain relief after the first injection, however, it is not unusual for someone to need more than one injection to get the intended long-term benefits. If this is the case, the injections are given in a series of three injections, if needed, roughly a month apart. If the pain is significantly improved, no further injection is needed unless or until the patient begins to experience pain again. 

What Can I Expect from an Epidural Steroid Injection Procedure?

All epidural steroid injections are a minimally-invasive procedure that are performed in an out-patient setting. They are very technique-sensitive, meaning it’s very important to have the procedure performed by a highly trained pain management specialist who can ensure the best results. 

The patient will lie on his/her back or stomach, depending on the injection placement. The provider will clean the skin of the injection site, and use a small needle to inject local anesthesia to numb the area where the epidural will be inserted. Most patients report that this step is the most uncomfortable part of the entire treatment. 

The provider will then use an imaging machine, such as fluoroscopy or X-ray, to guide the needle into the exact desired location in the epidural space where the irritated nerves are located. The medication, which is a mix of a steroid (to combat inflammation) and a local anesthetic (for immediate pain relief by disrupting the pain signals from being sent to the brain). 

The entire procedure takes around 30 minutes. Patients can expect mild discomfort around the injection site, and can plan to rest for the remainder of the day. Some patients report feeling discomfort around the injection site, which is usually calmed with the help of ice packs and ibuprofen. Patients should also take their time resuming activities. Full effects could take a few days to be felt, and patients can expect to feel pain relief from anywhere for a few weeks or up to a year. 

What are the Risks and Benefits of Epidural Steroid Injections?

Epidural steroid injections are a common form of therapy for certain causes of chronic back pain, with about 9 million injections performed a year in the U.S. The benefits far outweigh the risks, but it’s up to you and your healthcare provider to determine if this treatment option is right for you. 

Risks include bleeding and infection at the injection site, and post-dural puncture headache. There are rare cases of nerve damage, but this is why it’s important to trust a trained specialist who uses imaging machines to guide the needle. Allergic reactions with the steroid medications could lead to weight gain, anxiety, arthritis, ulcers, bone loss in postmenopausal women, or brief decrease in immune system function. 

While epidural steroid injections are a great option for most patients, there are some patients who are not a candidate for this treatment option. Patients who have an allergy to any anesthetic, are on blood thinning medications, have an active infection, or who are pregnant or might be pregnant may not be able to take advantage of this treatment option. 

Benefits include minimally-invasive, relatively painless and safe pain relief, which is felt immediately and could last for up to a year or longer. Patients can expect to achieve a better quality of life and enjoy both physical activity and possibly physical therapy to ensure long-lasting results. Epidural steroid injections also offer patients the ability to avoid dependency on medications and surgery. Lastly, they provide doctors with an important diagnostic tool for patients who might be experiencing pain from more than one location in the body. 

Overall, the amount and duration of pain relief varies from person to person. The result of epidural steroid injections is based on many factors, including the patient’s cause of pain, their health, family and medical history, and their activity level. Most patients are able to find pain relief that lasts for years, while others experience only short-term relief. However, all results are beneficial. If epidural steroid injections work to provide short-term relief, or it fails to provide the relief the patient and doctor are intending, then it’s a powerful diagnostic tool that gives enough feedback to move toward another treatment plan with another minimally-invasive treatment option. 

Why Would I Want an Epidural Steroid Injection?

As far as minimally-invasive treatment options are concerned, epidural steroid injections are one of the most safe, comfortable and effective ways to manage chronic back pain. They are not only an effective method for diagnosing and treating a variety of painful back and neck conditions, but they can also delay the need for more invasive surgical treatments. ESIs are one of the most common treatments used as of late for the successful management of chronic pain and disability. Furthermore, epidural steroid injections are considered a relatively low risk, inexpensive, and safe procedure that has proved to be an effective treatment option for patients who are experiencing chronic back pain, and specifically those cases dealing with nerve compression and/or irritation. 

If you have questions about epidural steroid injections, would like more information, or believe they may be a good option to help you get out of pain, please reach out to the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas to schedule an appointment. Our team of dedicated pain management specialists is available to partner with you to help you get out of pain now and avoid chronic pain in the future.