Epidural Steroid Injections

Article submitted by Dr. Gregory Paine of Naples Day Surgery. He can be reached at 436-6711 or visit his website at www.GregPaineMD.com.

If you suffer from neck or low back pain that radiates into your arms or legs, you are not alone. Back pain is only second to the common cold in number of patient visits to physicians. Almost 40 million Americans suffer with back pain. Perhaps you or someone you know is considering whether or not to have an epidural steroid injection.

There are a variety of indications to receive epidural injections which include: degenerative disc disease, vertebral compression fractures, herniated discs, shingles, etc. If your primary care physician feels you may benefit from an epidural injection, they will refer you to a pain management specialist for evaluation. Not everyone is a candidate and there are some conditions that prevent some from having this procedure.

Steroids are the ultimate anti-inflammatory medication and by putting them into the epidural space, the inflammatory cycle is likely interrupted enough to prevent continued pain and allow for healing to occur. We have all seen the asthmatic using their oral inhaler. The asthmatic is delivering their medication to the lungs. By putting steroids into the epidural space, the medication is placed into or very close to the affected tissues. This is important as many side effects from taking oral steroids such as an upset stomach or bad dreams, etc. are avoided or greatly reduced.

So what exactly is the epidural space? It is an area of fat and blood vessels that lies around the spinal cord. If you can visualize an archery target, think of the spinal cord as the bull's eye. The next ring is the fluid that surrounds the spinal cord. The next ring is the fibrous sheath known as the dura that holds in the spinal fluid. The next ring is the epidural space. Through this area, spinal nerves pass on their way from the spinal cord to other parts of the body.

The steroids take a minimum of 12-24 hours to take effect and in some cases as long as one week. Generally the patient should be seen within 2-4 weeks after having their injection for reevaluation. Some patients require up to three within a short period of time to break the cycle of inflammation, however three is not automatic for everyone. Although the literature supports administering an epidural steroid injection every 9 weeks, by keeping the amount of steroid to three injections or less, the concern for steroid side effects are minimized. There is one exception and that applies to the diabetic patient. Patients with diabetes must meticulously check their blood sugar as the steroids can dramatically elevate their blood glucose. Patients need to be very careful if they feel amazingly better after their injection as they can injure themselves by overdoing it. In other words they feel so good, they attempt doing activities they haven't done in years such as rearranging the furniture and often re-injure themselves. It is important if someone obtains good relief after their injection, they begin strengthening their back in a cautious manner.

Epidural injections can be considered a relatively low risk, potentially high yield procedure. The risks include bleeding or infection; there is a risk it may not work, or may make the pain worse; there is less than a one per cent chance of getting a special type of headache and a remote chance of damage to adjacent structures. If you have an active infection, it is best to wait until that clears before receiving an epidural injection. If you are on blood thinners such as plavix or coumadin, you likely will need permission to hold that for a few days prior to having your injection. Most people tolerate this procedure very well and the most discomfort experienced is usually with injection of the local anesthetic to numb the skin, much like at the dentist.

Everyone is different and it is impossible to tell who will benefit and who will not. I tell patients epidural injections are like pregnancies, meaning epidurals are different among individuals and each epidural is a little different for each patient. Some patients only require one epidural and never need another one, some require a few injections up front, others, require being on a maintenance schedule where they receive one every three to four months or longer and for some it may not be effective.

Epidural steroid injections can be very helpful in alleviating neck and back pain. For the safest outcome, make sure you are seeing a legitimate, fellowship trained, board certified pain physician for this type of procedure and you should do well.