What is an Epidural Steroid Injection?
An Epidural Steroid Injection (ESI) is a simple, safe, and effective non-surgical treatment that involves the injection of a steroid medication similar to cortisone into the Epidural Space of the back. The epidural space is the portion of the spine where inflamed nerves are located. The intent of this procedure is to reduce inflammation and therefore relieve pain. Performed by an interventional pain management, ESI is a minimally invasive technique used to relieve a variety of painful conditions, including chronic pain anywhere in the spine.
How is this injection done?
The most common technique employed by interventional pain management specialists now is with X-Ray guidance (fluoroscopy), usually with the patient lying on his or her stomach. The injection is performed under local anesthesia and, on occasion, with intravenous sedation. Patients are not deeply sedated or completely asleep for this procedure because it is unnecessary and unsafe to do so. The procedure usually takes no more than 5-10 minutes, followed by a brief 15-20 minute recovery before discharge home.
What types of conditions will respond to Epidural Steroid Injection?
For over forty years, ESI has been used to effectively treat chronic neck and back pain as well as a variety of other conditions. The most common diagnoses treated with ESI include herniated or bulging discs, spinal stenosis, and recurrent pain following spine surgery. Other conditions that may also respond to ESI include spondylolisthesis (slippage of the vertebral column) and post-herpetic neuralgia (pain after shingles).
Does the injection hurt?
The injection of local anesthetic (numbing medicine) at the beginning of the procedure may sting some, but ESI is an otherwise routine procedure that is extremely well tolerated by patients ranging in age from the mid-teens to well over ninety years old.
What should I do to prepare for my injection?
If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure.
If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.
What should I expect after the injection?
You may notice some reduction in your pain for the first 1-2 hours after the injection if local anesthetic is injected with the steroid. When this anesthetic wears off, your pain will return as it was before the procedure. The pain relief with ESI generally occurs within 3 - 5 days, some patients experience improvement before or after this time period. Diabetic patients should be on the alert for a rise in blood sugar during the first few days after injection and must monitor blood sugar accordingly.
What should I do after my injection?
Following discharge home, you should plan on simple rest and relaxation. If you have pain at the injection site, application of an ice pack to this area should be helpful. If you receive intravenous sedation, you should not drive a car for at least eight hours. Patients are generally advised to go home and not return to work after this type of injection. Most people do return to work the next day.
How many injections will I need during my treatment?
Sometimes it may require three injection sessions with an interval of two weeks between each session. However, the number of injections that you may require will depend on your response to each individual injection. If you have no pain following one injection, you will probably not need any additional treatment.
Could there be side effects or complications?
Minor side effects from the injected medications are not uncommon and can include nausea, itching, rash, facial flushing and sweating among other things. Some patients notice a mild increase or worsening of their pain for the first day or two after injection. Fortunately Epidural Steroid Injection has an extremely good safety profile, and serious complications are quite rare. Just like any other medical procedure, there are potential complications associated with ESI.
What are the chances that this treatment will help my pain?
Most studies show that this treatment helps relieve pain for approximately half (50%) of the patients treated. The degree and duration of pain relief are variable and depend on many different factors, including the underlying diagnosis or condition being treated, duration of symptoms before treatment, whether previous back (neck) surgery has been performed and other factors.
Can these injections be repeated if my pain returns?
YES! This ESI can definitely be repeated if it was helpful for your pain in the past. Although there is some flexibility in the timing of repeat injection, Dr. Hijazi will probably want you to wait for at least four to six months after your last injection. This issue can be discussed during a follow-up office visit.
STEROID SIDE EFFECTS
Epidural steroids may rarely produce unwanted side effects. Some of these potential side effects include increased blood sugar or hyperglycemia (especially in diabetic patients), fluid retention, elevated blood pressure, and transient redness or facial flushing. (Side effects from steroids may be common if they are taken daily over a length of time, rather than as an isolated epidural injection.)