Epidural Steroid injection

Pain experience on any level can be problematic. It can inhibit a person from experiencing an ideal quality of life, as well as keeping them from being able to sit, stand, walk, run, or even move. For patients who are suffering from chronic pain and have yet been able to find relief from conservative methods, epidural steroid injections could be the ideal solution. This minimally-invasive option provides patients with profound pain relief as it is a great method for treating several different causes of pain. If you are tired of living with chronic pain and don’t want to deal with surgical options, epidural steroid injections are worth considering. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas are available to help diagnose and treat your specific cause of chronic pain with a goal to provide pain relief using the most comfortable and least invasive options as possible. 

What is an Epidural Steroid Injection?

An epidural steroid injection (ESI) is a minimally-invasive treatment option that helps patients who are suffering with chronic pain finally find relief. The treatment itself is an injection of a local anesthetic and a steroid or corticosteroid, both of which work to provide immediate pain relief as well as a reduction of inflammation. The injection is placed in the epidural space, which is the space around the spinal nerves, and targeted at the specific nerves that are believed to be sending pain sensations to the brain.

The most common pain that epidural steroid injections target is called radicular pain. Radicular means “root” and refers to an irritated nerve root (radiculitis), or could also refer to weakness in the affected nerve root (radiculopathy).

• Radicular pain: generally radiates from the spine down an irritated spinal nerve root
• Lumbar radiculopathy: irritation in the lower back portion of the spine that causes pain in the leg
• Cervical radiculopathy: irritation in the neck portion of the spine that causes pain in the arm

Epidural steroid injections help to treat all of these causes of pain by treating nerve compression, whether that be in the neck or low back. This benefit of this injection is two fold as it helps to provide short term pain relief, as well as helps a person to more comfortably utilize physical therapy and additional treatment options.

How Does an Epidural Steroid Injection Work? 

The spinal cord is a very important bundle of nerves that runs from the brain to the lower back. In addition to the nerves, there are also vertebrae, ligaments, muscles, connective tissue, blood vessels, etc. that help to connect the different parts of the body. Every part works together to help the body move, the brain to register, and the body to feel. If there is an issue in the spinal column, there is a great chance that it is felt in another part of the body, such as the legs, feet, arms, hands, neck or head. This is what makes an epidural steroid injection so effective. 

When nerve roots that are attached to the spinal cord become inflamed or irritated, i.e. a herniated or bulging disc, pain isn’t necessarily felt in the spine, but down the arm or leg. The medication delivered through an epidural steroid injection coats the irritated nerves and reduces inflammation and subsequent pain. Additionally, this injection helps to identify the specific nerve that is causing chronic pain, allowing a healthcare provider to then recommend more long-lasting treatment options. 

What Conditions Does an Epidural Steroid Injection Treat?

Epidural steroid injections are used by healthcare providers to help patients manage their chronic pain that is caused by nerve root inflammation in the spinal column. There are many reasons why a person might experience nerve root inflammation, which is what makes an epidural steroid injection so helpful because it has proven helpful in treating all of them. 

The most common conditions that an epidural steroid injection can treat are: 

• Spinal stenosis
• Degenerative disc disease
• Herniated disc(s)
• Spondylosis
• Sciatica
• Bone spurs
• Scoliosis

The overall benefit of epidural steroid injections is that it allows a person to regain their active lifestyle by combating their pain symptoms. It does not fix the underlying health issue, but is used as a tool for helping a person to more comfortably utilize additional pain management therapies and treatments. 

In fact, roughly three out of four patients who had an epidural steroid injection experienced immediate pain relief. The treatment is also safe and effective enough that providers have been able to offer multiple injections as a way to provide a greater control of chronic neck pain. 

What are the Different Types of Epidural Steroid Injections?

Because the spine is so long, there is an equally great length of epidural space. The location of the epidural space injection depends on the nerve area that is thought to be causing pain. The locations include cervical (neck), thoracic (upper and middle back) and lumbar (low back). Regardless of the location, the injection involves a steroid and an anesthetic, which work together to help reduce pain as well as inflammation. The three main different types of epidural steroid injections are: 

1. Intralaminar injection: An injection delivered into the midline of the back that provides short-term pain relief
2. Transforaminal injection: An injection delivered through the side of the vertebra above the opening for the exiting nerve root. This offers a more specific approach to pain relief, and is especially effective for patients who have foreign bodies from previous surgeries (i.e. pins, screws) as this injection method can avoid those areas. 
3. Caudal injection: Delivered via the tailbone, this method allows for a catheter to be placed which permits a greater amount of medication to be delivered to help treat a greater amount of damaged nerve roots. This is often used in conjunction with the Racz procedure, which helps to eliminate scar tissue. 

Epidural steroid injections are a very common form of therapy for certain causes of chronic pain. The best way to determine which type of epidural steroid injection is best for you and your cause of nerve pain is to partner with a pain management specialist who can accurately diagnose your location of pain and recommend the best treatment option. 

What Does an Epidural Steroid Injection Procedure Involve?

An epidural steroid injection is a minimally-invasive outpatient procedure, which means that the patient is able to return home the same day. The injection procedure, however, is very technique sensitive, so it’s important to partner with a pain management specialist who has experience with these procedures. This will help to 

Prior to the procedure, your healthcare provider will review your health and medical history, as well as use diagnostic tools (X-rays, MRI and CT Scan) to determine the best location for the injection. It’s important to let your provider know if you are pregnant or might be pregnant, as well as detailed information about any medications, supplements and non-prescription drugs you might be taking. 

The first step of the procedure is for the patient to lie flat on their stomach, or on their side. The provider will then sterilize the area to minimize the risk of infection. They will use a small needle to inject a local anesthesia into the area of the body where the epidural will be inserted, with the goal to reduce any pain sensations during the epidural injection. Once the area is numb, the provider will use an imaging technique, either fluoroscopy or X-ray, to help guide the needle into the exact correct position in the epidural space to target the specific irritated roots. The provider will then inject a long-lasting steroid, which helps to reduce inflammation, as well as an anesthetic, which helps to reduce pain. In addition to targeting the specific roots at the injection site, the medication spreads to other areas in the spine, helping to provide even greater pain and inflammation relief. 

The entire procedure takes around 30 minutes and is generally painless. After the procedure, the patient is instructed to take the remainder of the day to rest. Mild discomfort can be felt at the injection site, so over-the-counter medications can help. It’s best to also gradually begin normal activities and not rush into any exercise regimen. Most patients report a reduction of pain within a few days, which continues for weeks or even a year. Patients are also able to receive multiple injections throughout the year, which help to provide continued relief of pain symptoms, especially while other treatment options are used to address the underlying cause of pain. 

What are the Benefits and Risks of an Epidural Steroid Injection?

Epidural steroid injections are considered a low risk, high reward treatment option for patients who have been living with chronic pain. While pain relief does vary from person to person, most patients can expect some form of short-term pain relief, and some can experience long-term pain relief. Not only does it offer relief when other treatment options have failed, it can also help a person to avoid or postpone any surgical options. These injections are also a great diagnostic tool as they can help determine if the pain is just coming from the irritated nerves in the epidural space, or if there is another source of pain. Overall, an epidural steroid injection helps a patient to immediately improve their quality of life and return to their normal daily activities without pain. 

As with any procedure, there are some risks involved. The most common risks are bleeding or infection at the injection site, as well as a post-dural puncture headache. There is also the possibility of nerve damage. Properly cleaning the injection site, as well as using imaging guidance, helps to mitigate any chance of experiencing these risks.  

Additional risks, while rare, can include: 

• Elevated blood sugar from the medication
• Weight gain from the medication
• Anxiety
• Arthritis
• Stomach ulcers
• Bone loss in postmenopausal women
• Limited decrease in immune system function
• Negative reaction to the medication, such as hot flashes or a rash
• Low blood pressure and feelings of lightheadedness

It’s important to discuss all possible risks with your provider prior to receiving an epidural steroid injection. Also, partnering with a pain management specialist who has experience in these injections will help to minimize any risks associated with treatment. 

Can an Epidural Steroid Injection Help My Chronic Pain?

If you are experiencing chronic pain that hasn’t responded to other conservative treatment options, an epidural steroid injection is a great next step. Epidural steroid injections have proven effective for treating chronic pain symptoms, providing the majority of patients with immediate pain relief. While results can vary and depend upon health history, underlying cause of pain, and activity level, most patients have found an enjoyable amount of relief with these injections, enough so where they could return to an active lifestyle and experience a greater quality of life. 

Epidural steroid injections are also a great option for patients who aren’t able to undergo surgery, or who would like to avoid surgery, and associated risks and possible complications, as long as possible. 

The best way to determine if an epidural steroid injection can benefit you is to discuss your current chronic pain symptoms and lifestyle goals with your pain management specialist. They will be able to explain the benefits and risks, as well as perform an exam to determine if these injections are the best course of action for you. 

The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas believe that no one should have to live with chronic pain. There is an ideal treatment solution for all pain sensations, and we are dedicated to helping our family of patients find the best treatment option that works for them. Epidural steroid injections could be the safest and most minimally-invasive option to help get you out of pain, both in the short term and in the long run. If you have questions or would like more information about epidural steroid injections and how they could benefit you, please schedule an appointment today!