What Back Pain Treatment Options Are Available To Me Are Epidurals Safe Effective For Cronic Back Pain
There are many methods for treating back pain at home, but only a few of these have been proven to be effective. The most common treatment is rest and applying ice to the painful area. This treatment is very relaxing and should be used for only 10-20 minutes. It should never be applied while you sleep. Also, exercise and stretching exercises are essential for keeping muscles and supporting tissues flexible. While some of these methods may not seem like they are effective for you, they can help you overcome your back pain.
Physical therapy is a good option for treating back pain. It will help you improve your posture and strengthen your core muscles. Massage therapy and acupuncture are other options for relieving tension and reducing joint pain. Some people also find that water therapy improves flexibility and balance, while yoga helps them heal faster from injuries. Proper nutrition and lifestyle changes are also important for treating back pain. It is very important to consult a physician if you are experiencing back pain because it will help you avoid more serious conditions later on.
How Does It Work
The immune system is basically our bodys built-in defense system. Its designed to fight against invaders, from bacteria to unknown viruses. So if youre injured or something in your body isnt working, your immune system is the first one on the scene, so to speak.
The immune systems first response is inflammation. The goal is to kill off as much bacteria as it can around the damaged site before it needs to call in reinforcements.
Of course, your body isnt meant to stay in a state of inflammation for an extended period of timeits a temporary measure until your immune system has moved on. So if the inflammation goes on for an extended period of time, it causes pain.
When cortisone is released by the adrenal gland, it has the opposite effectit suppresses the immune system in a targeted area, reducing inflammation and thus reducing the associated pain.
When you get an epidural steroid injection, youre taking advantage of naturally-occurring processes in the body. But instead of waiting for the cortisone to release on its own, your doctor is giving you a concentrated dose of artificial cortisone to hold the pain at bay for an extended period of time.
Are Epidural Steroid Injections Safe
Back pain can sideline you for weeks, months, or years. Depending on whats causing your pain, you may be able to treat it with an epidural steroid injection.
Our team of doctors at Spinal Diagnostics specializes in identifying the source of your back pain and helping you manage or eliminate it. For patients in Portland, Tualatin, and Newberg, Oregon, we employ a variety of pain management techniques, including our most effective — an epidural steroid injection.
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Interlaminar Epidural Steroid Injection
These shots can be given anywhere on the spine and are particularly effective when treating back, leg, neck, and arm pain.
After thoroughly evaluating your medical history and chronicling your pain, we recommend the type of epidural steroid shot he thinks matches your needs best. If the thought of an epidural steroid injection of any sort makes you uncomfortable because you simply dont like needles, rest assured the process is brief and painless.
When you come to Advanced Spine and Pain for an epidural steroid shot, we make you as comfortable as possible. First, we give you a local anesthetic at your injection site so you feel nothing during the procedure. Getting the injection takes only 10-15 minutes on average, but if your condition and pain are more severe, you may get more than one.
After your injection, we observe you for about half-an-hour to ensure that you dont have any reaction, and then youre on your way. If you have any tenderness, an ice pack does the trick.
Its also important to know that its normal to experience a bit more pain directly after getting the injection and a few days afterwards. You also might feel immediate relief, though improvement often continues for the next two to four days. Best of all, the relief your injection provides keeps you pain-free for a number of months.
Call the Advanced Spine and Pain office thats most convenient for you to schedule an epidural steroid injection consultation today, or reach out to us through our website.
How Painful Is A Lumbar Epidural Steroid Injection
Youll likely experience a minor pinch when your provider injects the local anesthetic to numb the area before your lumbar epidural steroid injection.
You may not feel anything during your lumbar ESI, or you may feel the following:
- A burning sensation.
- Momentary pain.
If you have any discomfort during the injection, it usually goes away once the injection is finished. If you feel intense, sharp pain during or after your lumbar ESI, tell your provider immediately.
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What Are Epidural Injections
An epidural injection contains a steroid medicine, usually together with a local anaesthetic. These injections are also called epidural steroid injections. The liquid is injected into a gap called the epidural space, which surrounds your spinal cord. The steroid reduces inflammation around your spinal cord, while the local anaesthetic provides faster pain relief.
The injections can be given at different points along your back. An injection in your lower back is called a lumbar epidural. There are different techniques for giving epidural injections for lower back and leg pain:
- interlaminar this is given between two of your vertebrae
- transforaminal this is an injection into the side of your spine
- caudal this is given through an opening at the base of your spine
How Do I Get Ready For An Epidural Steroid Injection
- An epidural steroid injection is generally an outpatient procedure. You may be asked to change into a surgical gown to make the injection process easier.
- You may want to ask for a mild sedative, but most people receive just local anesthetic.
- If you have diabetes, an allergy to contrast dye, or certain other medical conditions, you’ll want to discuss any concerns with your healthcare provider before getting the procedure.
Based on your medical condition, your healthcare provider may request other specific steps.
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Preparing For An Epidural Injection
Your doctor will explain how to prepare for your procedure. You’ll need to go into hospital to have an epidural injection from a pain specialist or spinal surgeon. You’ll usually have the injection and go home later the same day. Make sure that you arrange for someone to drive you home, and preferably stay with you overnight.
You may be asked to stop eating and drinking for several hours before having an epidural injection. Youll usually still be allowed to have clear fluids up to a couple of hours beforehand. Follow any instructions given to you by your doctor.
Tell your doctor about any medications youre on. If youre taking any medicines, particularly blood thinning medicines, you may be asked to stop taking these for a few days before the procedure. Never stop any medication unless your doctor tells you to.
Neurological Complications Associated With Esis
In 2009, FDA began evaluating serious neurological complications associated with ESIs. Between 1997 and 2014, a total of 90 serious and sometimes fatal neurological events were reported to the FAERS, including cases of paraplegia, quadriplegia, spinal cord infarction, and stroke.34 Potential causes of these AEs included technique-related issues such as unintentional intrathecal injection, epidural hematoma, injury to the spinal cord, direct injury to the arteries feeding the spinal cord, and embolic infarction due to inadvertent intra-arterial injection. Several potential risk factors, procedure-related and patient-related, were identified, including the level of spinal injection, the method of approaching the epidural space , and the degree of patient sedation. Cervical injections, in particular, were associated with these AEs, especially spinal cord injury, some of which were due to the vascular anatomy of the cervical region whereby unintentional intra-arterial injection with the transforaminal approach is more likely than in the lower lumbar region.
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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, 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.
Risk Associated With Particulate Steroids
Larger particles in particulate steroids may lump together and block blood vessels, causing reduced blood supply to the spinal cord.5–7
Risks and complications are typically higher in epidural steroid injections administered above the L3 level.3,8 The most common risk is the injection of steroids into a blood vessel, which becomes more likely to occur in people over 50 years of age.7 Rarely, an allergic reaction to the steroids, local anesthetic, or contrast dye may occur.
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Lower Risk At Spinal Levels L4 And Below
In general, epidural injections administered for spinal levels L4 or lower carry a lesser risk of complication compared to higher levels.10,11 The injections are typically performed under fluoroscopy with a contrast dye. Fluoroscopy helps guide the needle to the accurate location and helps prevent nerve and/or artery damage.1
The Effect Of Epidural Injections
An epidural steroid injection, or epidural for short, contains an aesthetic to provide temporary relief from chronic pain. Longer-term relief comes from the effects of the injections steroid.
The steroid effectively reduces inflammation and thus decreases or eliminates neck, back, arm, and leg pain caused by compressed or inflamed spinal nerves.
We deliver the injection into the epidural space, which is a fat-filled area that lies between the spine and the protective membrane covering your spinal nerves. Pain relief typically lasts about three months, but many of our patients experience longer-lasting results.
Epidural injections are a way to soothe nerve irritation, but they dont actually heal the problem causing your pain. They are effective in reducing inflammation, so you may be more responsive to other treatments that could improve your long-term function.
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What Are Other Nonsurgical Alternatives For Back Pain Relief
Although magic pills dont exist, back pain shouldnt be a thing that you just have to live with. There are many other minimally invasive choices to help you feel healthier and significantly improve your quality of life.
According to Dr. David Lloyd, neuroradiologist with Dignity Health, Yavapai Regional Medical Center and Vascular and Interventional Specialists of Prescott, vertebroplasty is a highly effective and noninvasive back pain relief alternative to epidurals.
Vertebroplasty is commonly recommended for compression fractures of the spine, which are most often found in osteoporosis patients. A cement-like material is injected into the broken bone to stabilize the fracture. Most patients experience pain relief and the renewed ability to go back to their daily activities almost immediately.
Who Should Get Epidural Steroid Injections
These injections do not provide relief for every kind of back pain. If you have general lower back pain or pain that does not travel down your leg, it might not be right for you.
If, however, your pain does travel down your leg and you have been dealing with it for over six weeks, you may be a good candidate. Conditions that can cause this kind of pain include:
- Spinal stenosis
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How Does An Epidural Work
An epidural anesthesia injection works by injecting an anesthetic into the epidural space around your spine so that it can stop pain signals from traveling from your spine to your brain. The epidural space is filled with fluid and surrounds your spinal cord. Think of it as a liquid sleeve around your spinal cord.
Your spinal cord acts like a highway that connects the nerves located all over your body to your brain. When you get injured, for example, the nerve in that area of your body sends a pain signal that travels through your spinal cord to your brain and back. An epidural anesthetic temporarily numbs the spinal nerves, which then blocks pain signals in a certain region of your body depending on where along your spine your provider injected the epidural.
Epidural anesthesia can provide temporary pain relief or a temporary total lack of feeling. The following factors contribute to how much feeling you temporarily lose from an epidural:
- The type of anesthetic drug your provider uses.
- The concentration of the drug .
- The dosage of the drug.
Possible Side Effects Of Epidural Steroid Injections
Side effects after an epidural are usually not serious. A few examples include 2,3:
- Fainting due to anxiety from the procedure causing a sudden decrease in heart rate and blood pressure
- Flushing of the face
These side effects typically resolve with rest. Injection site pain, if present, may be treated with cold therapy using ice packs to reduce pain and/or swelling.
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How Does A Lumbar Epidural Steroid Injection Work
Healthcare providers may recommend lumbar epidural steroid injections for chronic pain management. Your provider injects a steroid or corticosteroid medication into the epidural space by your spinal cord in your low back.
The lower back region of your spine is called the lumbar spine. This region is made up of five vertebrae, and these vertebrae are the largest of the other vertebrae in your spine. They extend from your lower thoracic spine to your sacrum .
Your vertebrae are the 33 individual, interlocking bones that form your spinal column, which runs from the base of your brain to your tailbone. These bones help protect your spinal cord from injury while allowing you to twist and turn. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.
The five vertebrae in your lumbar spine are named lumbar 1 through lumbar 5 from top to bottom. The lumbar vertebrae have several important roles, including:
- Supporting and stabilizing your upper body.
- Allowing twisting and bending movements.
- Protecting your spinal cord and cauda equina .
Your spinal cord is a very important bundle of nerves that runs from your brain to your low back. Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can communicate with the rest of your body.
The Risks Of Epidural Steroid Injections
In April 2014, the U.S. Food and Drug Administration issued a drug safety communication entitled FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain . The FDAs warning even stated that they could result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death .
The side effects of epidural steroid injections are so severe that the FDA ruled that all injectable steroid must carry an updated warning that includes the above risks, as well as arachnoiditis, bowel/bladder dysfunction, headache, meningitis, paraparesis/paraplegia, seizure, sensory disturbances .
The FDAs website also warns that the effectiveness and safety of injection of corticosteroids into the epidural space of the spine have not been established, and FDA has not approved corticosteroids for this use . This is largely due to the fact that research into the risks of epidural steroid injections is still being conducted. Approved or not, Dennis Capolongo of the ENDC, a ground that has campaigned against epidural steroid injections for years, believes that warning labels need to be stronger, and more visible not just confined to the small print.
In a forum on SPINE-health, one woman with pain in her lumbar spine described her first steroid injection as following:
While this pain-relieving procedure may initially provide some relief, the scary symptoms and risks make it not so worth it.
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When Epidural Steroid Injections Dont Provide Lasting Relief
When chronic back pain is caused by lumbar spinal stenosis , all you want is lasting relief so you can get back to your daily life. This was true for Dante Lavino, a patient who was struggling with constant and debilitating LSS pain. Dantes ability to play golf declined and he even had trouble getting up from his couch. This simple action required him to lean on the coffee table and rest for 15 to 30 seconds before straightening himself up to begin walking. Over time, he was unable to walk without resting.
Potential Benefits Of Epidural Steroid Injections
Most practitioners will agree that an epidural injection can be beneficial during an acute episode of back and/or leg pain. The main drawbacks of the injections are that they are not always effective, and when effective, the pain relief tends to be temporary, ranging from one week to one year. Typically, if the initial injection is effective, up to 3 injections may be given in one year.
When administered in the lumbar epidural space, steroid injections may have the following benefits:
- Reduce nerve pain and inflammation. Steroids decrease the production of inflammatory chemicals and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals.3,4
- Limit oral medication. Pain relief from these injections may help limit or eliminate the need for oral medications,4 some of which may have side effects when taken long-term.
- Continue or re-engage in physical therapy. This injection may provide sufficient pain relief to allow a patient to progress with a rehabilitative physical therapy program.1
- Postpone surgery. Pain relief experienced from lumbar epidural steroid injections may help postpone surgery, and if physical therapy is effective, it may eliminate the need for surgical intervention.4,5
Several techniques may be used to administer an epidural injection depending on underlying the condition, the patients needs, and the doctors preference and experience.
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