Living With Chronic Pain

When Do Epidural Injections Help Chronic Pain?

Most of us who suffer from back pain have periods that are worse than others. Many times sleep, exercise, eating healthy, topicals, medications, and physical therapy help. But too often, they stop working and these conservative measures don’t relieve the agony- especially if the problem is back pain caused by irritated spinal nerves. Sometimes, if you’re like me, just getting to the bathroom may start to feel like an impossible obstacle to overcome. This may be when a cortisone injection may help.

What is an epidural steroid injection (ESI)? 

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc disease. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years. The goal is to reduce pain so that you can resume normal activities.

A steroid injection includes both a corticosteroid (e.g., triamcinolone, methyl-prednisolone, dexamethasone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the bony vertebra and the protective dura sac surrounding the spinal nerves and cord.

Side view of the spine

ESI is not the same as an epidural anesthesia given just before childbirth or certain types of surgery. Corticosteroid injections can reduce inflammation when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves by flushing away the proteins that cause swelling. Pain relief can last from days to years, allowing your spinal condition to improve with physical therapy and an exercise program. 

Who is a candidate?

Patients with pain in the neck, arm, low back, or leg may benefit from ESI. Specifically, those with the following conditions:

  • Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
  • Spondylolisthesis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, it can compress the nerve roots causing pain.
  • Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve. 
  • Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
  • Neuropathic pain: Pain that courses along a usually compressed nerve root in to either  an arm or leg.

ESI has helped some types of inflammatory conditions. They also help to determine whether surgery might be beneficial for pain associated with a herniated disc. Resolution of the pain into the affected extremity after an epidural can confirm it’s the cause. When symptoms interfere with rehabilitative exercises, epidurals can ease the pain enough so physical therapy and other interventions can be started.

ESI should NOT be performed on people who have an infection or have bleeding problems. The injection may slightly elevate the blood sugar levels in patients with diabetes or temporarily elevate blood pressure and eye pressure for patients with glaucoma due to the steroids injected. You should discuss this with your healthcare provider.

Steroids shots have risks

Harmful side effects of cortisone injections are uncommon, but they do happen. The main risk is infection, which occurs less than 1% of the time. Less commonly, the needle could injure a nerve or blood vessel.

Having too many injections in the same target area can cause nearby tissues, such as joint cartilage or bone, to break down. Corticosteroids can also cause skin at the injection site or the soft tissue beneath it to thin. This is why it’s recommended to limit the number of cortisone injections to three or four per year, at any body region treated. When everything else has failed, or intermittent exacerbation hits and conservative treatments aren’t working, this may be an option to investigate. I know it’s been a valuable one for me.


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