How Will I Feel After The Injection
Most people do not feel any different immediately after the injection, although the pain may be temporarily improved or worsened. The steroid takes two to three days to start to have an effect in most people, and it peaks in about two weeks. Therefore, it may be a while before you feel a change in your pain.
Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three to four times a day will help this. You may take your usual pain medications as well after the injection.
When Should You Consider Epidural Steroid Injections
Whether you realize it or not, epidurals arent just used to ease pain for women about to give birth. These injections can also provide short-term pain relief for certain types of back pain.
If you are living with severe back pain, the expert providers at the International Spine Pain and Performance Center in the Washington D.C. area may be able to use epidural steroid injections to give you relief from the pain.
Here are a few factors to consider when youre deciding whether epidural steroid injections are right for you.
What Causes Spinal Headaches After Epidural
When an anesthesiologist inserts the needle for an epidural, they risk inserting it too far. This occurs in about 1% of all epidural placements.
When the needle goes too far, it is known as a dural puncture. A dural puncture can cause spinal fluid to leak, which can trigger a post-epidural headache within
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Questions To Ask Your Doctor
Have a think about any questions you would like to ask your doctor before you decide whether to have an epidural spinal injection or not. Here are some example questions you might like to ask.
- What other treatment options do I have to relieve my pain?
- What can I expect to happen after Ive had my epidural injection?
- Will I be able to exercise after the injection? Are there any types of exercise that it’s best not to do?
- Should I have physiotherapy or other some rehabilitation after having my epidural injection?
- How can I tell if my epidural injection has worked? How long will it take until I know if it’s worked?
- What is the likelihood of the procedure working? How long will the effects last?
- How will you reduce the risk of complications?
What Causes Back And Leg Pain
There are many causes for your back and leg pain. A common cause is an injury to a disc. The problem starts when a disc shifts out of place leading to a disc bulge or a herniated disc. When a disc presses on a large spinal nerve, the injured nerve becomes inflamed and causes pain.
Your disc injury may feel like back pain and the nerve injury as shock-like pain that travels to the buttock, legs or feet. Back pain and pain that travels to the leg may start at the same time or separately.
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What Is An Epidural Corticosteroid Injection
In the simplest of terms, an epidural corticosteroid injection is a way to deliver pain medicine quickly into the body with a syringe.
The medicine is injected into the epidural area. This is a fat-filled area that covers the spinal cord to protect it and the surrounding nerves from damage.
Sometimes pain relief is short term. Other times the benefits continue for some time.
What Are The Risks Of A Thoracic Epidural Injection
A thoracic epidural is a fairly safe procedure. But it does carry some risks. To help reduce these problems, healthcare providers usually use X-rays to guide them. Possible risks include:
-
Bleeding
-
Temporary nerve paralysis
There is also a chance that the shot wont ease your pain.
Your own risks may differ. They depend on your age, your other medical conditions, and the reason for the shot. It might not make sense for you if you have certain health conditions. These include an infection, a bleeding disorder, or uncontrolled high blood pressure. Talk with your healthcare provider about your specific risks.
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What Is An Epidural Injection
An epidural injection is an injection of medication into the space around the spinal cord, also known as the epidural space, to provide temporary or prolonged relief from pain or inflammation. The epidural space is the outermost part of the spinal canal. Steroids, anesthetics and anti-inflammatory medications are typically delivered in an epidural injection. The injection may reduce pain and swelling in and around the spinal nerve roots, as well as around damaged nerves which in time may heal.
Imaging guidance, such as fluoroscopy or computed tomography , may be used to help the doctor place the needle in exactly the right location to target the specific area causing the pain so the patient can receive maximum benefit from the injection.
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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What Is An Epidural Spinal Injection And How May It Help Reduce Back Or Leg Pain
A spinal epidural injection places anti-inflammatory medicine into a specific region of the spine’s epidural space. The medication helps decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
Will I Have Any Restrictions On The Day Of The Procedure
You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you.
No heat is to be used in the injected areas for the remainder of the day. You should not take a tub bath, hot shower, or soak in water for the remainder of the day.
You may eat, drink and take your medications as usual on the day of the procedure unless told otherwise by your doctor.
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What Are The Different Kinds Of Epidurals
There are different variations of epidurals based on certain factors. This section will explain different kinds of epidurals grouped into the following categories:
- How the medication is delivered.
- Labor and childbirth epidurals.
Epidural medication delivery options
There are a few ways your healthcare provider can deliver medication with an epidural, including:
Labor and delivery epidurals
There are two general kinds of epidurals that you may choose during labor and childbirth. These include:
- Epidural with a catheter: Your provider will administer medicine through a catheter in your lower back that they insert with an epidural injection. The catheter remains in your epidural space so that your provider can give you more medication if needed.
- Combined spinal-epidural : A CSE is a combination of two injections: a spinal injection and an epidural. A CSE provides pain relief much faster than just an epidural. Because it involves a lower dose of medication, youll have a bit more feeling in your lower half. This allows you to move around more easily and change positions. This type of epidural is often called a walking epidural, but most people arent able to fully walk with this kind of epidural.
Epidural steroid injections
People who have pain in their neck, arm, lower back or leg due to the following conditions may benefit from epidural steroid injections:
How Long Does An Epidural Last
How long an epidural lasts depends on what kind of epidural you got and what kind of medicine your healthcare provider injected. Your provider will let you know what to expect. In general, heres how long certain types of epidurals last:
- Epidural with a catheter: If you have an epidural with a catheter, your provider can give you a continuous flow of anesthetic medicine or multiple separate doses, depending on your situation and pain level. Once your provider has stopped the medication, youll likely experience numbness for a few hours before the effect of the medicine begins to wear off. Youll likely have to rest in a lying or sitting position until you have full feeling in your legs again. You may feel a slight tingling sensation while youre waiting.
- Single-injection epidural: Single injection epidurals usually last a few hours before you begin to regain feeling in the area that was numb.
- Epidural steroid injection: The length of time an epidural steroid injection can provide pain relief varies. Some people experience permanent pain relief if they have a new disk herniation. For people who have chronic pain, epidural steroid injections usually last 3 to 6 months or more.
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What Are The Different Types
There are two basic epidurals in use today. Hospitals and anesthesiologists will differ on the dosages and combinations of medication. You should ask your care providers at the hospital about their practices in this regard.
Regular Epidural
After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloroprocaine, or lidocaine.
This helps reduce some of the adverse effects of the anesthesia. You will want to ask about your hospitals policies about staying in bed and eating.
Combined Spinal-Epidural or Walking Epidural
A spinal block is sometimes used in combination with an epidural during labor to provide immediate pain relief. A spinal block, like an epidural, involves an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working quickly, but it lasts only an hour or two and is usually given only once during labor. The epidural provides continued pain relief after the spinal block wears off.
When Is An Epidural Steroid Injection The Best Choice For Managing Your Back Pain
Back pain is tricky business. It can stem from a variety of causes and result in an array of symptoms. Sometimes your backs just achy from overuse, and a gentle massage or a warm bath can relieve your pain. But if your back has been bothering you for more than six weeks, or if youre pain is so extreme its debilitating, its time to seek professional help.
Here at the Premier Spine Institute, Bonaventure Ngu, MD, specializes in helping people manage and even eliminate their back pain through a series of conservative, noninvasive, minimally invasive, and surgical treatments, including epidural steroid injections.
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What Is A Lumbar Epidural Steroid Injection
An epidural steroid injection is a procedure in which your doctor injects steroid medication into the epidural space. The epidural space is located inside the bony spinal canal but outside the tube that holds the spinal fluid. It extends from the base of the skull to the base of the spine.
When a steroid is put into the epidural space, it can reach the spinal discs and nerves, reducing inflammation and relieving pain. The goal of a lumbar epidural steroid injection is to decrease lower back or lower extremity pain caused by one or more compressed or inflamed spinal nerves in the lower back .
Epidural Vs Natural Birth
Roughly 60% of women in labor choose to have an epidural as a form of pain relief. However, a woman does not have to have an epidural to give birth.
Whether a woman chooses to use an epidural during labor is her choice, but women should keep as open a mind as possible. Sometimes, a doctor may need to administer an epidural or another type of pain relief. This might happen if, for example, a woman requires a cesarean delivery.
If an individual chooses not to have an epidural, other pain management techniques may be available. However, not all hospitals offer all the options, so women should talk to their healthcare providers about pain relief options when they present.
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How Is An Epidural Nerve Block Performed
An epidural nerve block is a procedure to block pain by injecting anesthetic medication into the epidural space of the spine. The procedure numbs the relevant nerve region thereby blocking the transmission of pain signals from those nerves to the brain. An epidural nerve block may be administered in the cervical, thoracic, lumbar or the caudal region of the spinal column.
The epidural space is the area between the inner wall of the backbone and the outermost of the three membranes that surround and protect the spinal cord. The space between the inner two membranes is filled with cerebrospinal fluid that supplies nutrients to the spine and acts as a shock absorber.
An epidural nerve block may be performed to
- Induce loss of feeling before a surgery
- Provide pain relief
- Long-term for chronic pain syndromes
An epidural nerve block is usually an outpatient procedure when performed as treatment for chronic pain. Steroids can also be administered to reduce inflammation. A pain management specialist performs the procedure that may take up to 30 minutes.
When an epidural nerve block is performed for anesthetic purposes during surgery or for pain relief post-surgery, the procedure will require hospitalization. Epidural nerve block may be the sole form of anesthesia or may be combined with general or spinal anesthesia .
Preparation
Prior to an epidural nerve block, the patient may be required to
The patient must
Procedure
Will I Be Asleep For This Procedure
This choice is yours. You can choose to have the procedure done under local anesthetic only. You can also choose to have IV sedation, which can keep you very comfortable. It can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level, regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation. It is OK to take your medications with a sip of water with either decision.
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Risks Involved With Esi
This procedure has very few risks, except temporary localized pain from the injection. Rarely, there may be a puncture of the sack containing spinal fluid, or other rare complications such as infection, bleeding, nerve damage, etc. Side effects of the injected steroid are generally temporary and include hot flushing, temporary weight gain, a short-term increase in blood sugar, etc.
Possible Side Effect Of Epidural Injections
The common, and usually not serious, side effects of epidural injections include:
- Nausea
- Fainting due to anxiety from the procedure
- Flushing of the face
These side effects will eventually subside after a few hours of rest. Cold therapy using ice packs can reduce any post-treatment pain and swelling.
The serious risks of the injection are as follows:
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How Is This Injection Done
Although there are different techniques used for Epidural Steroid Injection, the most common technique employed by interventional pain management specialists now is with X-Ray guidance , usually with the patient lying on his or her stomach. Dr. Zeballos uses fluoroscopy for all of his ESI procedures. The injection is performed under local anesthesia and, on occasion, with intravenous sedation. Patients are not deeply sedated or completely asleep for this procedure because it is unnecessary and unsafe to do so. The procedure usually takes no more than 5-10 minutes, followed by a brief 15-20 minute recovery before discharge home.
How Can An Esi Help Me
- ESIs decrease pain in the low back
- No drowsiness unlike some pain medications, there is no drowsiness after an ESI
- Based on a patients response after an ESI, a doctor can decide where a back surgery needs to be done in the future
- An ESI is a minimally invasive procedure there are no scars -there is only a small entry site where the needle is placed past your skin
For a patient success story, after treatment at NSPC,
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