Pain Management

Physical Therapy

 

Epidural Steroid Injection

demo imageEpidural Steroid Injection has been found to be an effective adjunct to treatment for patients with neck, lower back, arm, and leg pain. Commonly, nerves in the neck or back are compressed near the spine by a bulging disc, a bone spur, or scar tissue. This causes the nerve to become irritated and swollen, causing pain, numbness or tingling radiating into the arms or legs. The purpose of the epidural injection is to decrease inflammation and provide pain relief, thereby facilitating active therapy. Their primary use is as one component of a comprehensive treatment plan that includes medication, physical therapy, and education in body mechanics.

The success of the epidural steroid injection in relieving pain is due to the potency of the anti-inflammatory medication introduced into the epidural space. Cortisone is a powerful anti-inflammatory medication which reduces nerve irritation, thus reducing pain. As you may have heard, cortisone is sometimes associated with side effects such as puffy face, brittle bones, etc. These side effects typically occur in patients who are taking cortisone by mouth for long periods of time. With epidural injection, the cortisone acts locally on the nerves and herniated disc and systemic reactions are very rare.

The medication starts to work immediately, but takes about one week before it is entirely effective. Some patients feel relief upon injection, others in a few days to a week. You will be given an appointment for a follow up visit with your doctor to evaluate the success of the epidural injection approximately 4-7 days following epidural. If pain relief is not complete, the injection can be repeated after two weeks.

Possible side effects associated with the procedure include: numbness, dizziness, weakness for ½ hour to 4 hours after the injection; reaction to medication include minor or temporary allergic reaction which may include a temporary decrease in blood pressure (about 1 percent of the time); increased pain for one to seven days after injection; headache with or without spinal tap.

If you are having an epidural

In preparation for your epidural injection, you can have a light breakfast or lunch. Please do not consume any dairy products. Medications should be taken with a sip of water. We ask that you arrange for transportation to the facility. You can expect to be at the center for about an hour to an hour and a half.

What should I do about my regular scheduled medications?

Please let us know if you are on blood thinners such as Coumadin or if you have any disorders of blood clotting. If you are taking aspirin on a regular basis, please stop 7 days prior to injection. Please stop any anti-inflammatory medications 3 days prior. If you are on insulin or oral diabetic medication, please contact us for specific directions. Any other medication should be continued on the day of your appointment as usual.

May I drive myself home after the procedure?

No! Although most people are ready to go home within 1 hour or so from the injection, we strongly discourage driving for the remainder of the day. Activities thereafter unlimited with regard to the procedure.

What is the procedure?

The procedure is performed with you lying on your stomach on an x-ray table. In some instances, you may have an intravenous line inserted to provide you with extra fluid sand sedation. Your back will be “prepped” with an antiseptic iodine solution and a sterile plastic drape will be placed over your back. The skin area to be injected will first be anesthetized through a very tiny needle. The epidural needle will then be introduced through this anesthetized skin. As the needle is slowly advanced into the epidural space under x-ray guidance, it is rare to feel any pain.

 

Once the space is identified by the physiatrist (which may take anywhere from 30 seconds to several minutes), contrast dye is injected for confirmation of placement and the medication is slowly injected over 2-3 minutes, or less. The entire procedure usually takes less than 10 minutes. You will be given something to eat and drink in the recovery are. Discharge instructions will be given to you. It is advised that you rest for a few hours post procedure. You can resume normal activities the following day.

Immediately after the procedure

After the procedure, you may first notice a decrease or disappearance of your back or leg pain. Within 10-15 minutes you may feel a mild numbness or heaviness in your legs and lower trunk. This is occasionally associated with a mild lowering of blood pressure. You will continue to be monitored for 30 minutes after the injection. Shortly thereafter, you will be allowed to walk with a nurse and as soon as you feel stable walking alone you will be able to go home.

What should I expect the next days after the procedure?

As the local anesthetic wears off, your pain may return, although frequently not to the level it was before, and you may notice discomfort at the injection site. The steroid itself may take 2-4 days to take effect on the inflammation around the nerve, and therefore may take that long to help your pain. You should see your doctor 4-7 days after the injection to discuss your progress and future therapy.

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