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What Is An Epidural Injection For Back Pain

How Painful Is A Lumbar Epidural Steroid Injection

Ease Chronic Back Pain With Epidural Steroid Injections

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:

  • Pressure.
  • 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.

Aftercare For Epidural Injection

Your doctor or nurses will take you to a recovery room after the procedure. The nursing staff will monitor you for a short time before you’re able to leave. Sometimes, theyll ask you to lie flat for around 30 minutes or so. They may check your blood pressure or pulse, and ask if you’re experiencing any side-effects. The nursing staff looking after you will make sure that you can stand up when you feel ready.

You’ll usually be able to go home within a few hours after your injection, and sometimes much sooner. But youll need somebody to drive you home you won’t be able to drive yourself. Ideally, you should also have someone stay with you for your first night at home after your procedure.

It can take several days to feel any effects from the injection. In fact, some people find that their pain gets worse at first. This should settle down within a few days. Try to keep as active as you can, and as your pain improves, you can gradually increase how much you do.

How Do Epidural Corticosteroid Injections Work

Epidural steroid injections work by delivering a potent anti-inflammatory to the site of nerve impingement in the spine. Injected medications may include steroids, local anesthetics, and saline, and they can vary in volume and concentration on an individual basis.

Three routes may be used for epidural injections in the lumbosacral spine:

  • caudal
  • interlaminar
  • transforaminal

Your physician will choose which method is right for you based on your diagnosis and if you have had any prior spine surgeries.

  • A caudal injection is the least complicated way to access the epidural space but is also the least specific. It can be useful if multiple areas of the spine are involved or if post-surgical changes prevent other approaches.
  • An interlaminar injection delivers the medication directly into the epidural space at the affected level, can be targeted to one side or the other, and can treat multiple levels at once.
  • A transforaminal injection delivers the medication to the area where the specific affected nerve root exits the spine and is compressed by a disc herniation. It is the usual first choice approach for an epidural injection.

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What Are The Risks And Possible Complications Of Epidural Steroid Injections

Epidural steroid injections are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to ESI injections include:

  • Having low blood pressure, which can make you feel lightheaded.
  • Experiencing a severe headache caused by spinal fluid leakage. Less than 1% of people experience this side effect.
  • Getting an infection from the epidural procedure, such as an epidural abscess, discitis, osteomyelitis or meningitis.
  • Having a negative reaction to the medications, such as hot flashes or a rash.
  • Experiencing bleeding if a blood vessel is accidentally damaged during the injection, which could cause a hematoma or a blood clot to form.
  • Having damage to the nerves at the injection site.
  • Temporarily losing control of your bladder and bowels. You might need a catheter in your bladder to help you pee.
  • Getting ESI injections too often or receiving higher doses of steroid medication may weaken the bones of your spine or nearby muscles. Because of this, most healthcare providers limit people to 2 to 3 ESIs per year.

Can Epidurals Cause Lingering Back Pain Postpartum Experts Explain

Back Pain Management: Spinal Epidural Injections

The epidural I had during labor with my first born provided immense pain relief and proved extremely helpful when I ended up with an emergency C-section, but I had plenty of questions during recovery. When would the numbness wear off? Can epidurals cause lingering back pain postpartum? Will there be long-lasting side effects from my epidural?

More than 3 million laboring moms received epidurals in 2016, according to the Center for Disease Controls National Vital Statistics Report. Epidurals are widely used as pain relief during childbirth, and misconceptions about their effectiveness and side effects are also wide-spread.

Epidurals can cause short term back pain because the needle can bruise tissues. A tissue bruise from an epidural is like any other bruise one gets. Its sore for a few days but then resolves, McCallum R. Hoyt M.D. tells Romper. The needle can also bruise the periosteum which is the covering around bone. Should that happen, the bruise can last for a couple of months, but it too will resolve.

Research on whether or not epidurals caused chronic back pain was done many years ago, primarily in the U.K., Dr. Hoyt says. After 10 years of research looking at many factors, the evidence demonstrated that epidurals do not cause chronic back pain. However, the bruising can be a distinct possibility.


Dr. McCallum R. Hoyt, M.D., M.B.A., chair, Committee on Obstetric Anesthesia, American Society of Anesthesiologists

Studies Referenced:

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Myth No : You Cant Get An Epidural If You Have A Lower Back Tattoo

A lower back tattoo wont prevent you from receiving an epidural, but your anesthesiologist may want to avoid pigmented areas when administering the procedure. There is a theoretical chance that the needle can take a portion of the pigmented skin with it, causing a toxic reaction. However, this has not been scientifically studied. Im typically always able to find a spot where I can safely perform the procedure for patients with tattoos, says Dr. Higgins.

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Minimal Movement To Avoid Tenderness And Sensitivity

Because of the aforementioned proximity to most of the nerves in the body, most patients are advised a solid day or two of bed rest after an epidural. Not only does this help the medication disperse better throughout the body, but it also helps the patient cope with the physical recovery after having a sensitive procedure done.

Even though its a minimally invasive procedure, epidurals can still take quite a toll on the patient. Lumbar epidural steroid injections in particular can have effects like tenderness, inflammation, and sensitive skin around the injection site. If youve recently received an epidural, your doctor will advise that you stay put for as long as you can until your body recovers.

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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.

What Are The Risks Of An Epidural Steroid Injection

How Can An Epidural Steroid Injection Help Back Pain?

An epidural steroid injection generally causes no problems. If you do have side effects, they may include:

  • “Steroid flush,” or flushing of the face and chest, with warmth and an increase in temperature for several days
  • Sleeping problems
  • In rare instances, pain that actually increases for several days after the procedure

Serious complications are rare but can include:

  • Allergic reaction

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Can Getting An Epidural Cause Back Problems

Theres a common belief that getting an epidural will lead to back pain, but its very rare for an epidural to cause long-term or chronic back problems.

Its normal to experience temporary back pain or tenderness at the site of your epidural. This usually goes away within a few days.

This belief likely stems from the fact that many people who go through childbirth experience back pain after labor and delivery whether theyve had an epidural or not. This is because the bones and ligaments in your pelvis are shifting back into their original positions from before your pregnancy, which can cause back pain and discomfort.

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.

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How Do I Prepare For An Epidural

Your healthcare provider will give you specific instructions about what you need to do to prepare for your epidural. Be sure to follow their instructions. Your provider may:

  • Have you not eat or drink for a certain amount of time before your epidural.
  • Adjust certain medications youre taking, especially blood thinner medications.
  • Make sure you have someone with you to drive you home after your epidural.

Questions that may be helpful to ask your healthcare provider before you get an epidural include:

  • How often do you perform epidurals?
  • What do I need to do to prepare for my epidural?
  • What are the risks of getting an epidural?
  • What will my epidural feel like?
  • How long will my epidural last?
  • How long will it take to recover from my epidural?

Are There Safety Concerns

Epidural Steroid Injections: What to Expect

In 2012 there was an outbreak of meningitis caused by contaminated steroids. All cases came from facilities that used medications that were mixed in an unclean environment. The Los Angeles Minimally invasive Spine Institute only uses medications that are mixed in the operating room under clean and sterile conditions at the time of injection.

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Whats The Difference Between An Epidural And A Spinal Block

An epidural and a spinal block both provide pain relief through an injection in the area around your spine. The differences are the placement and the effect.

With an epidural, your healthcare provider injects anesthesia into the epidural space around your spinal nerves. With a spinal block, your provider injects the anesthesia into the dural sac around your spinal nerves that contains cerebrospinal fluid. This placement of a spinal block injection means that it gives immediate relief. Epidural injections usually take 20 to 30 minutes before you feel the full effect of pain relief or lack of feeling.

Alternatives To Epidural Spinal Injections

Your doctor will discuss your treatment options to help you decide whether or not to have an epidural for your lower back or leg pain. Most episodes of sciatica get better on their own in time, without the need for injections or other invasive treatments. There are many other methods for managing the pain, including painkillers and physiotherapy. You might decide to try or continue using these options rather than have an epidural injection.

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Who Performs An Epidural

An anesthesiologist or certified registered nurse anesthetist usually performs an epidural procedure. Anesthesiologists have special training in the field of anesthesiology, which is a medical specialty that involves the care of people before, during and after their surgery or procedure. Anesthesiology covers anesthesia, pain medicine, intensive care medicine and critical emergency medicine.

Healthcare providers of other specialties, such as neurology, may also perform an epidural. Again, theyre specially trained to properly and safely perform an epidural procedure.

For epidural procedures that use a catheter, a supporting healthcare provider is usually present to help as needed.

Treatment Of A Herniated Disc

Epidural Steroid Injections for Chronic Back Pain


Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone , and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication , without the need for surgical intervention.

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Data Sources And Searches

This quantitative systematic review and meta-analysis followed recent methodological guidelines., A search of PubMed and EMBASE databases using the terms epidural steroid, epidural injection, caudal, segmental nerve block, nerve root block, and transforaminal injection was performed without publication date or language restriction in April 2009, and repeated in October 2012. Besides online language tools, in-person translation services were provided through the Johns Hopkins Hospital international services translation program. Search limitations included RCTs and adults older than 18 yr of age. Additional studies were identified through hand searches of ESI review reference lists. and show further details of the search strategy. Among 690 potentially eligible studies, 244 duplicate references were excluded leaving 446 studies for evaluation, with another 356 deemed ineligible after initial abstract screening. This left 90 articles for final review.

How Common Are Cervical Epidural Steroid Injections For Pain Management

Cervical epidural steroid injections are a common form of therapy for certain causes of chronic neck pain. Cervical radiculopathy affects approximately 1 in 1000 adults per year, and neck pain is the fourth leading cause of disability in the United States. Over the past decade, the rate of cervical ESIs has doubled among people who have Medicare in the United States.

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How An Epidural Is Given

Epidurals are given by a specialist doctor called an anaesthetist.

You’re usually awake during an epidural, but for some types of surgery you may have it while under general anaesthetic.

  • A drip will be placed in your arm so you can be given fluids while you’re having the epidural.
  • You’ll be asked to sit down and lean forwards, or lie on your side with your knees up close your chest.
  • You’ll be given an injection of local anaesthetic to numb the skin where the epidural will be inserted.
  • A needle is used to insert a fine plastic tube called an epidural catheter into your back near the nerves that carry pain messages to your brain.
  • The needle is then removed, leaving just the catheter in your spine.
  • You may feel mild discomfort when the epidural needle is positioned and the catheter is inserted.

The epidural can be inserted at different levels of your spine, depending on the area of your body that needs pain relief.

Pain relief medicines are then given through the catheter. These take about 20 to 30 minutes to take full effect.

Your chest, tummy and legs may feel numb while the epidural medicines are being used, and your legs may not feel as strong as usual.

While the catheter remains in your back, it can be used to top up your pain relief medicines manually or using an automatic pump.

This can be for several hours or for a few days .

Mobile epidurals, which use a lower dose of pain relief medicines, are sometimes used in childbirth, allowing you to walk around during labour.

What Are Cervical Epidural Steroid Injections Used For

How Can Epidural Steroid Injections For Back Pain Help Me?

Healthcare providers use cervical epidural steroid injections to manage a type of chronic pain known as cervical radiculopathy, which is caused by spinal nerve root inflammation and irritation in your neck. Cervical radiculopathy can cause the following symptoms, which can radiate down from your neck to your shoulder, arms and/or hands:

  • Pain.
  • Muscle weakness.
  • Tingling.

Many conditions can irritate your spinal nerve roots in your neck and cause cervical radiculopathy, including:

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Myth No : Anyone Can Have An Epidural

Physicians assess epidural eligibility based on medical and personal history.

Women taking anticoagulation medications, or blood thinners, must stop these medications within an appropriate timeframe before labor to be eligible to receive an epidural. Women with other conditions, such as spina bifida, or who have had back surgery, may not be eligible to receive an epidural.

We highly recommend that women have a pre-birth anesthesia consultation so that the obstetrics and anesthesiology teams can create a care plan for their individual needs, says Dr. Higgins.

Do You Need Epidural Steroid Injections

If you believe an epidural steroid injection might be the right choice to treat your back pain, we can help you.

NWA Interventional Pain is a comprehensive pain clinic offering solutions to your chronic pain. We individually tailor your treatment plan to ensure that we treat your pain in the manner that is best for you.

If youd like to speak with us about your treatment options, use our contact page to get in touch.

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