When you hear the word “epidural,” you probably think of a woman having a baby. However, did you know that epidurals can be useful in other instances, too? One main use is in epidural pain management.
At Midwest Regenerative Health and Pain Clinic (MRHPC), we have realized that many of our patients who have received epidural injections for pain management didn’t even really know what an epidural was prior to receiving this type of treatment. So, what are epidurals, and how can they be used for pain management?
What Is an Epidural?
Epidurals are regional anesthesia injections placed into the epidural space right outside the membrane that protects the spinal cord. Unlike regular anesthesia, which leads to a total lack of feeling, epidurals are meant to provide analgesia or pain relief. Epidurals prevent you from feeling pain in the lower part of your body by blocking nerve impulses from the lower part of the spine. There is another type of epidural that is especially beneficial for pain management: epidural steroid injections.
Epidural steroid injections (ESIs) use corticosteroids to help reduce low back and leg pain. These injections’ goal is to reduce inflammation of the nerve roots in the area, which helps reduce pain.
Types of Epidural Steroid Injections
There are a few different kinds of ESIs, and they are often distinguished based on the injection location.
- Cervical epidural injections are given in the neck.
- Thoracic epidural injections are given in the middle back.
- Lumbar epidural injections are given in the lower back.
ESIs can also be named according to the path of the needle during the treatment. These would be called:
- Interlaminar epidural steroid injections are placed between the lamina; most epidural steroid injections are placed here.
- Transforaminal epidural steroid injections are placed along the nerve’s course and enter the spine at a diagonal.
When Are Epidurals and Epidural Steroid Injections Used?
The most common use of epidurals is pain relief during childbirth. An epidural is injected during labor to ease pain, and they are even used if a mother is having a cesarean (c-section).
Epidurals are also frequently used during and after some surgeries as the anesthesia when doctors don’t want to put patients under completely.
At MRHPC, we use epidural steroid injections for pain management for patients with chronic pain, including those with:
- Herniated discs
- Knee arthritis
- Hip arthritis
- Diabetic peripheral neuropathy
- Tendinitis and bursitis
- Spinal stenosis
- Pinched nerve
Not everyone is the right candidate for ESIs. If you have certain conditions or take certain medications, you might not be permitted to undergo ESIs.
How Are Epidural Steroid Injections Given?
An anesthesiologist, doctor, or nurse anesthetist is typically responsible for administering an epidural. First, and intravenous (IV) line is placed. Next, a local anesthetic will be applied to the injection site to numb the area. Then, the physician inserts the needle into place with a contrast dye. After the needle is in position, the corticosteroid medication and sometimes a local anesthetic are injected into the spinal column’s epidural space.
Studies have found that fluoroscopy is vital in guiding the needle to the correct area. In fact, more than 30 percent of ESIs that are done without fluoroscopy are incorrectly placed. For this reason, doctors use an X-ray machine along with a special dye to perform the procedure.
ESIs are performed on an outpatient basis. It takes about 20 to 30 minutes to prepare and insert the epidural, and then the patient is monitored for at least a few minutes before being released.
How Do Epidural Corticosteroid Injections Work?
The steroids are generally anti-inflammatory, and reducing inflammation can help reduce pain. Cortisone, Triamcinolone acetonide, Dexamethasone, and Methylprednisolone acetate are all commonly used steroids in epidural injections.
The local anesthetics used in these injections help with temporary pain relief. Lidocaine is a fast-acting anesthetic that is good for a short time, and bupivacaine is another option that tends to be more long-lasting. These local anesthetics are also used for flushing or diluting the chemical or immunologic agents in the body that cause inflammation.
How Should You Prepare for an Epidural Pain Management Appointment?
Before coming in for your steroid injection, your doctor will provide you with a list of instructions. These instructions will outline any medications you need to discontinue prior to the ESI, including blood thinners and anti-inflammatory medications.
You doctor will also let you know whether you should refrain from eating before coming in for the treatment. However, in most cases, patients are permitted to eat a small meal a few hours before the injection.
How Often Should Epidural Corticosteroids Be Injected?
Within six months, up to three injections can be administered. Injections typically occur two to three weeks apart. A set of three injections is common, even though many patients start to notice a considerable change after just the first or second injection. In some cases, doctors may decide to space the injections out throughout an entire year.
What Results Should Patients Expect from Epidural Steroid Injections?
The goal of epidural nerve blocks is to reduce pain. Patients should expect to feel the benefit of the epidural steroid injection two days after the treatment. Pain relief can last between a week a year, depending on the problem and the medications used in the injections.
Often, epidural injections are part of a treatment plan that also involves physical therapy. Together, these treatments can help many people get back to a pain-free life.
Epidural steroid injections tend to be more effective than oral steroids or painkillers because they are more focused at the site of pain. Also, chemical inflammation causes a vast majority of pain, and EPIs can help control this type of inflammation, unlike OTC painkillers.
What Should You Do After an Epidural Steroid Injection?
After you have an ESI, you should plan to rest for the remainder of the day. Bring someone with you to your appointment, because you shouldn’t drive or operate heavy machinery for at least 12 hours after the treatment. In most cases, you will be able to eat and drink without any restrictions.
Remember that mild drowsiness, numbness, and tingling or weakness in the legs is normal for the rest of the day. By the end of the day, these symptoms should gradually wear off.
Potential Side Effects of Epidural Steroid Injections
Every medical procedure comes with its own set of risks. With ESIs, there are a few common side effects and complications that you should be aware of. The most common side effects associated with epidural steroid injections include:
- Increase in local pain
- Facial flushing
- High blood sugar
- Stomach ulcers
- Non-positional headaches that resolved within 24 hours
- Decrease in immunity
- Arthritis of the hips
Common complications include:
- Infection: While severe infections are rare, if you believe that you have developed an infection, contact your doctor right away.
- Bleeding: Bleeding is a rare complication that is typically only found in patients with underlying bleeding disorders.
- Dural puncture: Also called a “wet tap,” dural punctures are reported in approximately 0.5 percent of injections. This means that spinal fluid is leaking from the spinal sac. Usually, the issue improves on its own, but sometimes it requires a blood patch to clot around and stop the leak.
- Nerve damage: Rarely, nerve damage can occur due to the trauma from the needle or any bleeding or infection.
After having an ESI, you need to be aware of your side effects. You should see a doctor if any of the following applies to you:
- Fever of 101 degrees or greater for more than 24 hours
- Loss of function of limbs
- Loss of bowel or bladder control after the local anesthetic and numbness wear off
- Painful headache while sitting or standing that feels better after lying down
- Severe pain that can’t be controlled by OTC pain medication
If you are experiencing any of the conditions listed above, Midwest Regenerative Health and Pain Clinic can help you determine if epidural steroid injections are right for you. You can set up an appointment with us today by calling us at 913-745-5300.