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Epidural Steroid Injection

What is an epidural steroid injection?

An epidural steroid injection (ESI) is a pain management option for patients with chronic and/or severe back pain. By injecting a steroid into the dura mater (a thick membrane surrounding the spine), your pain management specialist can provide temporary pain relief for weeks or even months. Epidural steroid injections may also be used as a diagnostic tool that helps identify the source of pain. By numbing different areas of your back, your physician may be able to pinpoint the precise location of your pain.

This type of steroid injection can be administered to the cervical (neck), thoracic (mid- to upper-back), and lumbar (lower back) regions of the spine.

What does an epidural steroid injection treat?

  • Herniated Discs / Pinched Nerves. When a disc herniates, the softer jelly-like inner ruptures through the tougher outer layer. This can irritate surrounding nerves, causing pain in the back and/or limbs. While ESI cannot “treat” a herniated disc, an injection can provide symptomatic relief for patients who have (1) not found relief through noninvasive treatments and/or (2) are awaiting surgery or another more invasive treatment option.
  • Inflamed Nerves. An inflamed nerve root – whether caused by a herniated disc, spinal stenosis, or bone spur – can cause pain, numbness, or tingling in the back, arms, and legs. An epidural steroid injection can minimize the pain of inflammation.
  • Spinal Stenosis. This condition (narrowing of the spinal column) can be congenital, but is more commonly caused by osteoarthritis and other types of bone degeneration. A compressed spinal column can put pressure on the nerves, which causes pain in other areas of the body. An ESI may provide pain relief for spinal stenosis.

How is the injection administered?

An epidural steroid injection is an outpatient procedure that is usually performed without sedation. When you come into Pain Management Associates at Hedley Orthopaedic Institute for your ESI, you may if necessary be given drugs to help you relax. This reduces anxiety about the epidural steroid injection. You will also change into a gown so that the physician can easily access the spine.

Next, you may be asked to lie face down on an x-ray table, if you are able. Real-time x-ray imaging (sometimes enhanced by the injection of a contrast dye) helps the physician know precisely where to administer the injection. Numbing medicines may be given to minimize the discomfort of the ESI.

Finally, the epidural steroid injection is performed. Dr. Kirk Bowden likes to keep patients in the office for at least 15-20 minutes following an epidural steroid injection in order to monitor for any allergic reactions or immediate complications. Assuming you have no difficulty, you can go home and rest for the remainder of the day.

How effective are epidural steroid injections?

The steroids typically take about two to three days to start working. According to numerous studies, at least half of all patients experience significant pain relief after an ESI. (Note, an epidural steroid injection will not cure the underlying problem or provide permanent relief.)

While “at least half” may not sound like a very confident outlook, you should consider that these studies do not always account for the various factors that may influence an ESI’s success. One of the most important factors is the physician’s experience and technique.

You have to consider, for example:

  • Is the doctor fellowship trained? Board certified?
  • How many ESIs have they performed?
  • Was an ESI the right treatment modality for the pain?
  • Did the physician use fluoroscopic guidance?

If the results of your ESI are good, then you may receive up to two to three epidural steroid injections per year. More injections per year could have negative long-term consequences. Also, if you and your physician feel that more injections are necessary to provide adequate relief, then it might be time to look for a different back pain management option.

What are the risks of epidural steroid injections?

Potential risks and side effects include:

  • Dizziness, nausea, and headaches
  • Allergic reaction to steroids
  • Nerve root damage (which could cause pain in the leg)
  • Spinal infection
  • Bleeding around the spinal column
  • Weakening of the vertebrae and spinal column (if too many injections are administered)

Is an epidural steroid injection right for your back pain?

Many patients who receive an epidural steroid injection find that the pain relief – even if minimal – is enough to get them moving again. Once you’re able to walk, climb stairs, and return to a normal life, you may find that your back pain continues to lessen. After all, one of the reasons back pain is so debilitating is that pain begets pain.

Take this scenario as an example:

  1. An inflamed nerve causes back pain, which prevents you from moving like you used to.
  2. You stop moving. As a result, your back becomes more stiff and painful until even walking is difficult.
  3. As walking becomes more difficult, you’re forced to spend most of your day on the couch or in bed… all because of the pain of an inflamed nerve, which could be treated directly with an epidural steroid injection.
  4. Once an ESI helps reduce the pain of the inflamed nerve, you can start moving again, exercising those joints in a healthy way.

Isn’t it time to break the cycle? For more information about epidural steroid injections – or to schedule an appointment – contact Pain Management Associates at Hedley Orthopaedic Institute. Pain management services offered in Mesa, AZ.


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