Epidural Steroid Injection
If you suffer from chronic back pain or neck pain, an epidural steroid injection may be a great option for reducing pain and improving your overall quality of life. Many patients see great effects from this procedure, with a fairly short recovery time.
There are few major types of and techniques for epidural steroid injections. We’ll discuss all of these throughout this post:
Cervical epidural steroid injections (to treat neck pain)
Lumbar epidural steroid injections (to treat back pain)
Transforaminal epidural steroid injections
Caudal epidural steroid injections
Interlaminar epidural steroid injections
Epidural steroid injections are injections into an affected area of a steroid medication and, at times, an anesthetic. These injections reduce pain mainly through their effects on inflammation. This is associated with the perception of pain, as the release of inflammatory molecules leads to chemical damage to nervous tissue, thus resulting in noxious (or painful) stimuli. Inflammation is thought to be a major factor in conditions such as arthritis and neuropathy. Steroids inhibit pro-inflammatory molecules, and thus may significantly reduce pain when introduced into tissues.
These drugs also promote normal nerve membrane formation and modulate the molecular basis of nervous signaling. This may also contribute to the control of pain. However, some researchers assert that this is not the only effect on pain associated with epidural steroid injections.
The injection of fluid alone may also affect pain by promoting blood flow through the vessels located in the epidural space. This is thought to inhibit the conductance of pain signals to a degree. The injected material may also cleanse damaged nerve cells. This may add to pain relief by washing away inflammatory molecules present in the epidural space.
The epidural space is often chosen as a target for medical intervention as it is near enough to one’s spinal cord to offer access to spinal nerve roots without excessive infiltration into areas such as the layer of cerebrospinal fluid as described above.
The epidural space is present in all spinal regions, meaning that pain in many areas of the body may be addressed by the application of epidural steroid injections. Injection into this area is commonly regarded as far safer than injection into other areas, such as the sub-arachnoid space or directly into nervous tissue, when wishing to deliver pain-relieving medication directly to the spine.
A typical epidural steroid injection procedure may be performed in an outpatient clinic or physician’s office, and takes about 15 minutes. Before an epidural steroid injection is performed, equipment to monitor vital signs (e.g. heart rate, respiration, and blood pressure) may be connected to the patient, especially if intravenous sedation is required. The physician or specialist may first clean and prepare the skin above the area to be injected.
The patient lies face down, so that the spine will be easily accessible. A steroid injection usually only requires topical local anesthesia to numb the skin. The epidural space of the region targeted is visualized using imaging techniques such as fluoroscopy. This enhances the accuracy of the specialist or physician as he or she inserts a needle and extends it within the vertebra toward the appropriate space. The use of contrast dye may also help ensure accurate needle insertion. Once accurate placement of the needle has been achieved, the steroids are injected in a volume sufficient to cover the area necessary (e.g. to reach and act on the nerve roots in question). An excessive volume of medication over too large an area may affect the risk of adverse events resulting from this procedure.
Epidural steroid injections are recommended for many pain conditions and disorders, including chronic back pain and neck pain. If you suffer from either of these conditions, talking to a pain doctor could help you learn more about this option.
A recommendation to perform a steroid injection depends on an accurate diagnosis of the underlying condition responsible for pain, however. This is likely to begin with in-depth interviews with a physician or pain specialist concerning the symptoms, symptom severity, as well as the location and duration of symptoms. This ensures accurate diagnosis and an idea of which region of the spine an epidural injection should target. In some cases, the symptoms and their characteristics are not specific enough to give a concrete diagnosis. In these cases, the pain doctor may diagnose based on the elimination of possible conditions. For example, in cases of lower back pain, the doctor may try to eliminate the possibilities of the most common conditions related to this, such as nerve root damage, before proceeding.
A doctor may also assess the patient for characteristics that affect the success of this treatment or of the likelihood of the recurrence of pain after an injection. These are also referred to as yellow flags, and may help the physician design a treatment plan appropriate to the individual patient. Yellow flags, depending on the pain research authority or association providing diagnostic tools to assess them, may include some of the psychosocial factors affecting treatment failure that are mentioned above.
Epidural steroid injections for back pain and neck pain
The vast majority of people may expect to be subject to some form of spinal pain at one point or another in their lifetime. Pain in the neck or back is associated with many factors, which may depend on the structure of the back. Some of these relate to the deterioration of the many types of tissue (e.g. bone, cartilage) that make up the spine. These effects may extend to other tissues or structures that attach the spine to the rest of the body (e.g. joints, ligaments, or muscles). Despite all these possibilities, some cases of pain arise without the detectable presence of any factors listed so far. This is known as idiopathic or unexplained pain.
Cervical epidural steroid injections are given to treat chronic neck pain, whereas lumbar epidural steroid injections treat pain in the back. Watch the following cervical epidural steroid injection video below to see how this procedure takes place.
In many cases, spinal damage or disorder results in pain or discomfort localized in the spinal region in question, which may also spread outward into the limbs. This pain may manifest in many different forms, or types, of pain. Some patients may describe their pain as being a concentrated stabbing sensation, while others may perceive it as less localized and duller. The characteristics of a particular disorder may change over time. In other words, some conditions may be associated with episodic pain, which persists over a certain period of time, then remits for another period of time to recur again for another. Some symptoms are specific to certain disorders. On the other hand, others may be a characteristic of many different conditions.
These may include:
Muscle stiffness or cramping
Weakness, numbness, or tingling in extremities
Pain onset, or sensitivity, to pressure or touch
Some conditions associated with consistent pain may not be treated with conventional treatments such as oral painkillers. Patients who experience these may be better suited to epidural steroid injection.
Epidural steroid injection is also commonly recommended to patients with the following conditions.
Intervertebral disc herniation
In these cases, the discs of cartilage that support vertebrae may impinge on spinal nerves or the spinal cord. This may require corrective surgery in some cases, but in less severe forms may be managed with pain-relieving interventions.
This is the chronic deterioration (or degeneration) of cartilage, associated with inflammation and pain.
Spondylolisthesis is a progressive spinal deformity. This is caused by the degeneration of the joints between vertebrae over time. This condition may not result in pain, but can become painful if the spinal cord or nerve roots are compressed by the increased deformation of spinal structure. Some reports estimate that approximately 5% of the population suffer from spondylolisthesis.
This is a relatively common form of cervical pain, in which the tissues within the cervical area are damaged by abrupt and violent jolting movements. These are typically linked to motor vehicle collisions and other high-impact events. Whiplash may be associated with chronic pain.
This is the compression of spinal nerves or the spinal cord, caused by the abnormal accumulation of tissue on the inside of the vertebral column. This may be associated with chronic pain that intensifies in response to activity, such as walking.
This is a degeneration of the normal structure of vertebrae, which may be associated with direct damage, conditions such as osteoporosis, or advancing age.
These are conditions that cause abnormalities in the structure of the spine, and may be genetic. These disorders include kyphosis or scoliosis. Spinal deformity may affect all regions of the spine.
Some patients with back pain have been found to be affected by infections of the spine. This possibility should always be eliminated in the diagnosis of patients presenting with pain accompanied by fever. Infection may also be considered if a patient is recovering from spinal surgery, may be immunocompromised, or has a history of regular medication intake or drug abuse.
Degenerative disc disease
This condition is associated with wear and tear to the discs over time. This results in injury to one or more discs, which may result in chronic pain. It can affect any region of the spine. The pain may spread to other areas or remain concentrated around the disc in question.
This is associated with nerve damage located in the lumbar region. This condition is associated with pain that spreads through a lower extremity.
A similar condition in which a nerve in the cervical region is damaged. This causes pain to radiate along an arm.
Failed back surgery syndrome
This often results from inadvertent nerve damage sustained in the course of surgery to correct another condition (e.g. radiculopathy). This may result in new-onset pain, which can become chronic. This pain may also result from the accumulation of scar tissue resulting from surgery, if this is near enough to a spinal nerve root.
Persistent or chronic pain continues to be a prominent healthcare and economic issue. Some estimates indicate that approximately 90% of people are likely to encounter some type of pain that affects their ability to function normally at some point. Back pain is a major component of the total incidence of all pain. It is associated with an annual economic burden of $100 billion or more. Chronic pain may be treated using several well-recognized therapies and applications. These include epidural steroid injection treatment, which is associated with effective relief from back and neck pain.
This treatment option is a safe, minimally-invasive procedure that may be an alternative to more extensive surgery. Many patients experience decreases in pain immediately after one of these procedures. The process of epidural steroid injection and the resulting effects on neck and back pain are well-documented in scientific and clinical literature.
Epidural steroid injections may treat pain associated with disorders of the spinal cord or of the spinal nerves that branch out from this to travel into the body. They are thought to reduce pain based on the anti-inflammatory properties of steroids and the beneficial effects of the injections themselves on epidural blood flow and nerve cells. However, epidural steroid injections may be associated with some adverse effects. Side effects include the increased risk of gastric disorders and arthritis, increases in bodyweight, and emotional changes.
Many patients react positively to a single injection. Others, however, may need multiple injections to achieve expected pain relief. In these cases, a physician or pain specialist may design a treatment schedule tailored to the individual’s needs. Epidural steroid injections have been associated with the reduced need for surgery in conditions such as radiculopathy. Their success may depend on many factors, however, including the time elapsed before adequate diagnosis and treatment of the pain type in question.