An epidural injection delivers steroids into the epidural space around spinal nerve roots to relieve pain - back pain, leg pain, or other pain — caused by irritated spinal ner ves. The steroid used in the epidural steroid injection reduces the inflammation of those nerves, which is often the source of the pain. It is important to note that an epidural steroid injection should not be considered a cure for back pain or leg pain: r ather, the goal is to help patients get enough pain relief in order to be able to progress with their rehabilitation program. An epidural steroid injection significantly reduces pain for approximately 50% of patients. It works by delivering steroids direc tly to the painful area to help decrease the inflammation that may be causing the pain. In addition to relieving pain, the process of natural healing can occur more quickly once the inflammation is reduced.
The injection procedure for an epidural includes the following steps:
The procedure usually takes approximately 30 minutes, followed by about 30 minutes of recovery time. On the day of the epidural steroid injection the patient should not drive. Rest is needed and strenuous activities must be avoided on the day of the epidural steroid injection.
Following the epidural injection, some partial numbness from the anesthetic may occur in the patient ’ s arms or legs. Any partial numbness usually subsides after a few hours. Any remaining pain needs to be reported to the physician.
There may be an increase in the patient ’ s pain that may last for up to several days. This may occur after the numbing medicine wears off but before the steroid has had a chance to work. Ice packs may help reduce the inflammation and will typically be more helpful than he at during this time. Improvements in pain will generally occur within 10 days after the epidural injection, and may be noticed as soon as one to five days after the injection.
Regular medicines may be taken after an epidural steroid injection. On the day following the procedure, the patient may return to his or her regular activities. When the pain has improved, regular exercise may be resumed in moderation. Even if improvement is significant, activities should be increased slowly over one to two weeks to a void recurrence of pain.
As with any medical procedure, there are certain drawbacks and potential risks associated with an epidural steroid injection for back pain, leg pain or arm pain. One of the most important issues to consider is that the procedure only tends to significantly lessen the patient’s pain about half of the time.
Unfortunately, epidural steroid injections are not always effective — it is estimated that they help relieve t he patient’s pain only about 50% of the time. In some cases the pain relief will be permanent. In others, the pain will be lessened enough to allow the patient to progress with rehabilitation and exercise, which helps the patient heal and find pain relief on a long-term basis.
If excellent pain relief is obtained from the first epidural injection, there will be no need to repeat it. If there is a partial benefit (greater than 30% relief from pain) the epidural injection can be repeated for possible addition al benefit, or it may be necessary to conduct additional tests to more accurately determine what is causing the patient ’ s pain. Up to three epidural steroid injections may be performed, spaced at least two to four weeks apart. If the initial injection prov ides minimal benefit (less than 30% pain relief) the physician may either repeat the injection, or try a different type of injection or treatment.
As with all invasive medical procedures, t here are potential risks associated with epidural steroid injections. However, in general the risk is low, and complications are rare. Potential risks include:
In addition to risks from the injection, approximately 2% of patients will experience side effects from the steroid medication, such as:
Lumbar epidural steroid injections should not be performed on patients who have a local or systemic bacterial infection, are pregnant (if fluoroscopy is used) or have bleeding problems. Epidural injections should also not be performed for patients whose pain is from a tumor or infection, and if suspected, an MRI scan should be done prior to the injection to rule out these conditions.
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