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 spine. 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.

Highlights

Although there are different techniques used for Epidural Steroid Injection, 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. Harbin Spine & Pain uses fluoroscopy for all ESI procedures. The procedure usually takes no more than 15 minutes, followed by a brief 15-30 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.

Risk Factors

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. Your physician will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.

Treatment

Although there are different techniques used for Epidural Steroid Injection, 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. Harbin Spine & Pain uses fluoroscopy for all ESI procedures. The procedure usually takes no more than 15 minutes, followed by a brief 15-30 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.

What should I do to prepare for my injection?

On the day of your injection, you can have a light breakfast and/or lunch. You must have someone available to drive you home. Your driver will need to arrive with you to check in and remain in the waiting room throughout your procedure. 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.

If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discontinue 7 days 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, just to name a few.

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, your physician will probably want you to wait for at least three months after your last injection. This issue can be discussed during a follow-up office visit.

Recovery

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. Although 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.  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.