If you suffer from chronic lower back pain or neck pain, epidural steroid injections could help you find relief. In this post, we cover some of the most common questions that are asked when it comes to this pain management option.
1. What is an epidural steroid injection?
Epidural steroid injections are a pain management treatment option that are typically used to treat lower back pain or neck pain. Doctors inject a combined anesthetic and steroid into the epidural space of the spine. This can relieve pain by reducing inflammation. Epidural injections can also diagnose the exact location of a person’s pain. Epidural steroid injections are an interventional pain management option, so they are only used after less invasive options like exercise, chiropractic care, or physical therapy haven’t led to pain relief for a patient.
These injections are an impressive treatment option for pain, though, because:
- They’ve been shown to be a relatively safe and minimally-invasive procedure for decades
- The injections have few side effects and complications
- Patients who receive this procedure often find pain relief in just a few days after the procedure
- Pain relief can last for up to a year after the procedure, allowing for physical therapy and rehabilitation
There are three major types of epidural steroid injections, which we’ll discuss in more detail below. They include:
- Interlaminar epidural steroid injections
- Transforaminal epidural steroid injections
- Caudal epidural steroid injections
You may also hear epidural steroid injections referred to by placement. A cervical epidural steroid injection, for example, is given in the cervical portion of the spine near the neck. A lumbar epidural steroid injection is delivered into the lumbar, or lower, spine.
2. What does an epidural steroid injection do?
The American Academy of Orthopaedic Surgeons reports the two major uses for epidural steroid injections:
“First, they can be performed to diagnose the source of back, leg, neck, or arm pain (diagnostic). Second, spinal injections are used as a treatment to relieve pain (therapeutic).”
Epidural steroid injections are typically used to relieve pain related to:
- Lower back pain
- Neck pain
- Disc herniation
- Spinal stenosis
- Degenerative disc disease
3. Do epidural steroid injections work?
According to most studies, more than 50% of patients will find pain relief with epidural steroid injections. This pain relief will be temporary. For some it will only last a few weeks or months, but it can last for up to a year after the procedure. This can allow patients time to resolve the underlying cause of their pain through physical therapy or exercise. Epidural steroid injections can also be given multiple times–up to three times a year–for longer lasting pain relief.
These benefits of an epidural steroid injection will vary depending on you, your condition, and the pain doctor you work with for the procedure. It’s been suggested that doctors who always use fluoroscopy for a more accurate placement of the injection have higher rates of success. Therefore, it’s important that if you decide to undergo this procedure that you work with a doctor who has extensive knowledge and practice in administering these injections.
4. What is the epidural steroid injection procedure?
The epidural steroid injection procedure involves injecting a medication into the epidural space where the damaged nerves are located. The injection typically includes a longer-lasting steroid with a short-term anesthetic for pain control during the procedure. The steroids work to reduce inflammation and irritation near the damaged nerve. MedicineNet gives a greater overview of the spinal cord anatomy in play with an epidural steroid injection.
The entire epidural steroid injection procedure takes less than 20 minutes. Many patients will find relief within one to three days of the procedure, and can resume normal functioning the day after the procedure.
The following video gives a greater in-depth look into the procedure itself and how it’s performed.
5. What is an interlaminar epidural steroid injection?
An interlaminar epidural steroid injection refers to how the needle is placed during the procedure. The interlaminar approach is the most common. EMedicineHealth explains how this technique works:
“Most epidural steroid injections are placed between the lamina, known as interlaminar epidural steroid injections. The lamina are portions of the bones on the back side of the spine that are arranged like shingles. The needle is aimed upwards toward the head and passes between two adjacent lamina.”
6. What is a transforaminal epidural steroid injection?
A transforaminal approach to epidural steroid injections are often suggested for patients with pre-existing surgical pins or rods. KnowYourBack explains:
“With a transforaminal ESI, often referred to as a ‘nerve block’, the needle is placed alongside the nerve as it exits the spine and medication is placed into the ‘nerve sleeve’. The medication then travels up the sleeve and into the epidural space from the side. This allows for a more concentrated delivery of steroid into one affected area (usually one segment and one side). Transforaminal ESIs can also be modified slightly to allow for more specific coverage of a single nerve and can provide diagnostic benefit, in addition to improved pain and function.”
Watch a transforaminal epidural steroid injection take place in this video from The Kahan Center for Pain Management.
7. What is a caudal epidural steroid injection?
Finally, a caudal approach to epidural steroid injections focuses on making the injection into the epidural space of the sacral region that sits at the end of the spine. With this approach, a doctor can inject more steroids, if needed, and it also has a smaller relative risk of dural puncture. However, it can be more difficult to achieve accuracy with this approach.
All three approaches for epidural injections have their relative benefits and risks. By talking to your doctor, you’ll be able to decide which one is the best option for you and your condition.
8. Are epidural steroid injections safe?
Epidural steroid injections are considered a safe procedure. They have been in use since the 1950s. They have received much clinical and empirical support as an interventional pain management option, especially in cases where other non-invasive treatment options haven’t worked. You can find a full list of clinical trials on epidural steroid injections here.
The most important factors for reducing your risk include:
- Working with a doctor who has extensive knowledge and expertise in performing epidural injections
- Avoiding the procedure if you have any complicating factors, such as diabetes, hypertension, or heart disease
- Undergoing no more than three procedures a year
- Using physical therapy or exercise following the procedure for longer-lasting pain relief
9. Are epidural steroid injections painful?
There may be some pain during the procedure, but it is generally mild. Interventional Spine and Pain reports that:
“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.”
Patients can also receive mild sedation to reduce anxiety and increase comfort, when necessary.
10. What are the side effects of epidural steroid injections?
Epidural steroid injections are considered safe procedures for the large majority of patients. There are side effects with this procedure, though. The most common are increased pain, bleeding, or swelling at the injection site, especially in the days following the procedure.
- Steroid flush, or skin flushing caused by the steroids
- An increased appetite
- Weight gain
- Changes in menstruation
- Changes in sleep quality, or insomnia
- Hot flashes
- Changes in blood pressure
- Water retention
To reduce your risk of both side effects and possible complications, those who have untreated hypertension or diabetes should avoid epidural steroid injections. Likewise, if you’re on medications to reduce blood clotting, have a pre-existing infection or chronic condition, or a sensitivity to steroids, you should avoid this procedure.
11. What are epidural steroid injection complications?
The majority of side effects and complications from epidural steroid injections are mild. However, more serious complications from epidural steroid injections include:
- Increased pain
- Infection at the injection site
- Nerve injury
- Muscle weakness
- Dural puncture
Stroke or paralysis are severe risks. Because of this, in 2015 a group of experts with the U.S. Food and Drug Administration Safe Use Initiative came together to establish guidelines to reduce as much possible risk from these epidural steroid injection complications. In the end, their report “Safeguards to Prevent Neurologic Complications After Epidural Steroid Injections” published in Anesthesiology presented 17 specific clinical considerations that can significantly reduce risk of complications for patients. Talk to your doctor about how they reduce the risk of complications in their practice.
Contact your doctor immediately if you experience any of the following symptoms after an epidural steroid injection:
- Loss of function or feeling in your arms or legs
- Severe fever of 101 degrees or greater, for more than 24 hours
- A painful headache that feels better when lying down
- Loss of bowel or bladder control
12. Can I expect pain after epidural steroid injection?
Some patients do report increased pain, especially in the days following the injection. This will typically be felt around or near the injection site.
You may also experience a slight headache after an epidural steroid injection, due to the effects of the steroids. However, if you experience a severe headache that feels better when you lay down, it may indicate a dural puncture. Columbia University Medical Center explains:
“A dural puncture occurs in 0.05% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually gets better within a few days. Although rare, a blood patch may be necessary to alleviate the headache.”
If you experience abnormally severe headache pain following the procedure, talk to your doctor so they can repair the damage if needed.
13. What does an epidural steroid injection cost?
The cost of an epidural steroid injection will vary based on:
- Your current insurance plan
- What doctor you visit
- Your location
Simply put, the total cost to you will depend. If you talk to your doctor about the procedure, ask them for all accompanying and possible costs associated with the procedure, and have them check with your insurance company before undergoing the procedure.
14. How many epidural steroid injections are safe?
Many pain doctors recommend no more than three epidural steroid injections per year. As Mayo Clinic explains, this isn’t because of the injection needle itself, but rather the steroids used in the procedure.
“Epidural steroid injections contain drugs that mimic the effects of the hormones cortisone and hydrocortisone. When injected near irritated nerves in your spine, these drugs may temporarily reduce inflammation and help relieve pain. But steroid injections also disrupt your body’s natural hormone balance. Delaying repeat injections allows your body to return to its normal balance.”
Your doctor will work directly with you to make sure there’s no unnecessary procedures done. If a course of injections don’t help your pain, they’ll likely discuss other options that could help you manage your pain.
15. What to expect after an epidural steroid injection?
A large number of patients are concerned with what happens after an epidural steroid injections. Like all pain management treatments, that will depend on your specific circumstances. However, most patients do report pain relief, and quickly–typically with two to three days. Others may wait up to two weeks before finding relief, while others may not experience any pain relief from this treatment option. As noted earlier, there may be some pain and swelling around the injection site.
In the hours following the procedure, Emory Healthcare discusses the most important guidelines for remaining safe:
“Be aware that the anesthetic will take several hours to wear off. It is imperative that you have someone drive you home, as you may experience some temporary loss of sensation and may find your motor coordination a bit awkward or weak. Otherwise, you may resume your regular activities the following day.”
If you’re ready to learn more about epidural steroid injections, reach out to a doctor today to learn if they could help relieve your pain.