Epidural Steroid Injections

An epidural steroid injection is an injection of local anesthetic and steroid into the epidural space. The epidural space is a space located within the spine, just outside of the sac containing spinal fluid.

The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. An epidural steroid injection will not correct the preexisting medical problem (such as spinal stenosis, herniated or bulging disc, arthritis, etc.) causing the pain, but it may improve the level of pain.

It is not unusual for someone to need more than one injection to get long-term benefit. The injections are done in a series of three injections about a month apart if needed. If the pain is significantly improved, no further injection is needed unless the pain begins to come back.

What can I expect on my first visit?

Your first visit is an initial evaluation. This appointment consists of reviewing your medical history, medications, x-rays, treatments already tried, and any other pertinent information and records. A physical exam will be performed. A plan of care will be formulated. If an epidural steroid injection is found to be appropriate it will be scheduled as soon as possible. Injections can only be done on the first visit if precertification arrangements have been made with your insurer to allow both an initial visit and a procedure on the same day.

What are the risks of the procedure?

The main risk, occurring in about one in 100 patients, is the risk of a dural puncture. (This rate is higher in patients who have had previous back surgery.) A dural puncture occurs when the needle is unintentionally advanced one layer beyond the epidural space and punctures the membrane that surrounds spinal fluid.

If this occurs, there is a risk of developing a spinal headache, which may be severe and may last for days. There is a procedure (epidural blood patch) that can treat the headache if it occurs and does not improve sufficiently in 48 hours.

Other risks are rare and include bleeding, infection, nerve injury and allergic reaction to the medication.

Some short-term side effects may occur. If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for one to two hours. If this happens you will have to stay in the Pain Management Center until this resolves.

You may have increased pain for a few days after the injection. People with diabetes may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for one to two weeks.

The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. For your safety, please make your doctor aware of any of these conditions.

Will the injection hurt?

Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure, although every person's response to any procedure is individual.

What happens during the actual procedure?

After you sign a consent form and your blood pressure is checked, the procedure will be performed while you are in a sitting position. For procedures in the neck, an intravenous is started.

The back or neck is then cleansed with an antiseptic soap. A sterile drape is placed. The skin is anesthetized (numbed) with a local anesthetic. This is felt as a stinging or burning sensation. The needle is then advanced into the epidural space. Pressure is the usual sensation. If you feel pain more local anesthetic will be used.

Once the needle is in the epidural space, the medication is infused and the procedure is complete. Your skin will be cleansed and a bandage will be applied. The bandage can be removed on the next morning. Your blood pressure will be checked, and you will be able to leave with your ride after the doctor authorizes your discharge.

How will I feel after the injection?

Most people do not feel any different immediately after the injection, although the pain may be temporarily improved or worsened. The steroid takes two to three days to start to have an effect in most people, and it peaks in about two weeks. Therefore, it may be a while before you feel a change in your pain.

Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three to four times a day will help this. You may take your usual pain medications as well after the injection.

Will I have any restrictions on the day of the procedure?

You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you.

No heat is to be used in the injected areas for the remainder of the day. You should not take a tub bath, hot shower, or soak in water (such as a pool or hot tub) for the remainder of the day.

You may eat, drink and take your medications as usual on the day of the procedure (both before and after) unless told otherwise by your doctor.

For what reasons should I call the Center for Pain Medicine after the injection?

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call the Center for Pain Medicine at 617-732-9060.

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