Low back pain is the leading cause of disability in the world, affecting people of all ages today. But those who suffer from the problem can count on a method widely used with great benefit in relieving pain: epidural steroid injections.
Epidural steroid injections are a common method of treating neck, mid and low back pain. In several cases, the spinal nerves become inflamed due to the inflammation and narrowing in their path from inside the spinal canal to the outside of the canal. The purpose of using these injections is to relieve pain, and often, the injection alone is enough to provide relief.
And that’s where epidural steroid injections come in. But do not think that this procedure is new. It has been used for pain since 1900s, and is still an integral and important part of the non-surgical treatment of sciatica and low back pain.
The first epidural injection for sciatica was described by Dr. Viner in 1925 even before Drs. Mixter and Barr described the herniated disks in 1934. Eighteen years later, Drs. Robecchi and Capra used steroids (hydrocortizone) for injection for the first time in 1952.
For which cases are epidural steroid injections indicated?
Epidural steroid injections are one of several non-surgical treatments to relieve acute and chronic back pain.
When spinal nerves become irritated or inflamed due to certain degenerative conditions in the spine, the steroids injected can relieve the inflammation and pressure on the nerves which are causing severe limb and back pain.
Before your doctor considers recommending spinal surgery or therapies to relieve chronic pain, he or she will likely recommend one or more nonsurgical treatments. And epidural steroid injections are one of those.
How is this procedure done?
The most common forms of epidural steroid injection are: interlaminar, caudal or transforaminal. All three methods involve placing a fine needle in the epidural space through the help of a fluoroscopy (X-ray). Usually, a local anesthetic is added with dexamethasone to provide pain relief.
Of the three options, the most popular method is transforaminal, also known as foraminal root block. The needle is placed near the nerve where it leaves the spine, called the root. The medication then propagates along the entire path of the root into the epidural space. This method provides the most concentrated injection of steroid into the affected region (typically a single segment and single side). Moreover, relief of pain after a foraminal block is also of diagnostic value in identifying the source of pain.
The epidural steroid injection is performed in a single day and the patient can now return to his activities a few hours later. This procedure may be performed with light sedation, although most patients tolerate it with only local anesthesia only.
And what happens after the epidural steroid injection is given?
The steroid usually starts working within 1 to 3 days, but in some cases it can take up to a week for the patient to feel the full benefit. Therefore, it is normal to feel pain for a few days.
Steroids are generally very well tolerated, however some patients may experience side effects including facial and chest flushing that can last for several days and may be accompanied by a feeling of heat or even a small increase in temperature, anxiety, difficulty sleep, changes in menstrual cycle or temporary water retention.
These side effects are usually mild and usually go away within a few days. If you are diabetic, have a dye-contrast allergy, or have other serious medical conditions, you should discuss them with your doctor before undergoing this procedure.
Am I a candidate for epidural steroid injections?
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