If you suffer from chronic back pain or neck pain, an epidural steroid injection may be a great option for reducing pain and improving your overall quality of life. Many patients see great effects from this procedure, with a fairly short recovery time.
There are few major types of and techniques for epidural steroid injections. We’ll discuss all of these throughout this post:
Lumbar epidural steroid injections (to treat back pain)
Transforaminal epidural steroid injections
Caudal epidural steroid injections
Interlaminar epidural steroid injections
Epidural steroid injections are injections into an affected area of a steroid medication and, at times, an anesthetic. These injections reduce pain mainly through their effects on inflammation. This is associated with the perception of pain, as the release of inflammatory molecules leads to chemical damage to nervous tissue, thus resulting in noxious (or painful) stimuli. Inflammation is thought to be a major factor in conditions such as arthritis and neuropathy. Steroids inhibit pro-inflammatory molecules, and thus may significantly reduce pain when introduced into tissues.
These drugs also promote normal nerve membrane formation and modulate the molecular basis of nervous signaling. This may also contribute to the control of pain. However, some researchers assert that this is not the only effect on pain associated with epidural steroid injections.
The injection of fluid alone may also affect pain by promoting blood flow through the vessels located in the epidural space. This is thought to inhibit the conductance of pain signals to a degree. The injected material may also cleanse damaged nerve cells. This may add to pain relief by washing away inflammatory molecules present in the epidural space.
How many people suffer from chronic pain?
Research on pain and pain management estimates that approximately 90% of the population will suffer from pain that appreciably affects their life quality and ability to function normally during at least one point in their lifespan. Reports from the Centers for Disease Control (CDC) state that consistent (or chronic) pain, including that felt in the spinal or back region, is related to significant debility in some cases. This may lead to profound effects on the personal and professional lives of those who are affected.
Therefore, chronic pain may also be associated with significant economic burden. Some reports lead to the conclusion that this form of pain is related to billions in lost income every year. In addition, it may be a prominent factor in skipped work days and in occupational injury claims. Chronic and painful conditions are commonly linked to increased healthcare burden and reduced productivity in the workplace. Therefore, a considerable growth in the area of medical research dedicated to treating and managing this pain has taken place in the last few decades. The last decade has seen a significant rise in the number of robust clinical trials in new and more effective therapies for chronic pain.
Epidural steroid injections for chronic pain
An end-product of these trials that is in common use nowadays are epidural steroid injections. These are minimally-invasive medical techniques associated with efficacy and reliability in chronic conditions affecting the spine (i.e. the neck and back). Many major health and pain research authorities support epidural steroid injections as a treatment option with positive effects on life quality for patients who are affected by conditions such as:
Radiculopathy (pain caused by damage to certain nerves that may also lead to chronic pain)
Epidural steroid injections are also recognized by as an aid to the restoration of normal function and daily activity levels.
Chronic spinal pain is a common topic in scientific literature, although interventions applied to this condition must undergo rigorous testing and trial processes before researchers will conclude that they are effective treatments for the condition(s) in question. This research has also found that there may be many underlying conditions that explain a particular type of pain, and that accurate diagnosis of these may affect the success of a certain therapy.
Epidural steroid injections have been found to be effective in cases of many of these disorders. This treatment has been shown to reduce or even eradicate pain in many cases. For patients who do not experience such pain relief after one injection, research has shown that a course of several injections over time may treat pain to an approximately equal effect. This treatment is associated with some side effects, mainly related to the drugs (i.e. steroids) included in the injections. Though rare, epidural steroid injection side effects may include:
Epidural steroid injection video — watch a procedure performed live!
The history of epidural steroid injections
Epidural injections were first introduced by the neurologist James Leonard Corning in 1885. Although his initial experiments incorporated cocaine (a socially-acceptable anesthetic at the time) as the injected material, it was not proposed specifically as a pain treatment for 16 years after this. By then, two other doctors were documented as using cocaine injections at a target in the base of the spine. The patients that this was tested on were described as suffering chronic pain of a form defined as intractable sciatica at that time (but may in fact have been a type of radiculopathy).
By the 1930s, a form of epidural injection known as a caudal injection was well-regarded in the literature as an effective form of pain relief. The formulations used were mostly local anesthetic medications, not steroids, however.