June 2022 / Back Pain

Epidural Steroid Injections for Back Pain

A Closer Look at a Common Treatment

Reports show that 50 to 85% of adults experience back pain at some point, with a high prevalence in adults who are 65 years of age and older. One widely used treatment for low back and leg pain has been fluoroscopically guided epidural steroid injections (ESIs).

Epidural Steroid InjectionIn basic terms, an epidural corticosteroid injection is a minimally invasive way to deliver anesthetic and anti-inflammatory medication into the body with a syringe. The medication is injected into the epidural space around the inflamed spinal nerves.

The level and length of pain relief can vary widely from patient to patient.

Looking at an Epidural Corticosteroid Injection in More Depth

Epidural corticosteroid injections inject a small dose of anti-inflammatory medication, called a corticosteroid, into the lower back to relieve pain in your lower back or legs. The medication is injected into an area surrounding the nerves in the spine called the epidural space. The medication acts to reduce inflammation, and in doing so, it can help to relieve pain.

In addition to being a treatment, epidural corticosteroid injections can be used by your doctor to identify and diagnose specific nerve root problems.

What Are Steroids?

There are two kinds of steroids. One kind are chemicals, often hormones, that your body makes naturally. They help your organs, tissues and cells do their jobs.

There is also a class of man-made medicines called steroids. The two main types of the second kind of man-made steroids are corticosteroids and anabolic-androgenic steroids (or “anabolics”).

Corticosteroids are medicines that quickly fight inflammation in your body. These lab-made steroids work like natural hormone cortisol that is made by our adrenal glands. Cortisol keeps our immune systems from making substances that cause inflammation. Corticosteroid medicines work in a similar way. They slow or stop the immune system processes that trigger inflammation.

Limiting the Use of Corticosteroids

For some patients, epidural corticosteroid injections provide thankful pain relief. But they are usually limited to just a few a year because there’s a chance for systemic side effects. These can include skin thinning, facial flushing, insomnia, moodiness, and high blood sugar. In addition, it’s important that after injections you have enough of a break so that your body can return to its normal balance.

For these reasons your doctor will carefully weigh the scheduling of any successive corticosteroid injections.

The Epidural Corticosteroid Injection Procedure

An epidural corticosteroid injection is done on an outpatient basis. It takes approximately 10 to 30 minutes and patients are lying face down during the procedure.

The medicine is injected into the epidural space in your spine using x-ray moving image guidance (using a fluoroscope) on a screen so that it can be targeted precisely. A local anesthetic is also used to help with pain relief.

After the Procedure

After the procedure is completed, you can return home. Normally you can resume normal activities the following day. The corticosteroid usually starts working within 2 to 5 days, although you may need up to a week to feel the full benefits of the procedure.

Many people experience many months of pain relief and improved function after an injection. However, if you don’t experience pain relief you should contact your health care provider as this may be a sign that your pain is arising from other conditions.

To find out more about epidural corticosteroid injections and whether they might be appropriate for you, please talk to your Main Line Spine doctor.

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