Epidural Steroid Injections: What to Know

When pain makes walking, bending, or even sitting tough, everyday life feels harder than it should. Chronic pain can be relentless, pushing many to seek relief beyond medication and surgery. 

Epidural steroid injections have gained attention as a potential option for managing nerve-related discomfort and supporting mobility. This minimally invasive procedure may help reduce inflammation and support physical therapy, offering temporary relief for some. 

This article explores how epidural steroid injections work, along with potential benefits and risks, to provide general information for discussion with a healthcare provider.

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What Is an Epidural Steroid Injection?

An epidural steroid injection (ESI) is a minimally invasive procedure designed to help manage nerve-related pain in the spine. 

It involves injecting a corticosteroid (an anti-inflammatory medication) and a local anesthetic into the epidural space surrounding the spinal cord and nerve roots.

ESIs may help reduce inflammation and offer temporary discomfort relief, which could support movement and participation in physical therapy.

While they don’t cure underlying conditions, they may help manage discomfort, which could make daily activities feel more manageable for some individuals. 

How It Provides Pain Relief

Spinal discomfort may be associated with inflamed or compressed nerves. ESIs are intended to:

• The steroid coats the irritated nerve(s), targeting the source of pain.
• It helps reduce swelling and pressure on the affected nerve(s).
• This process allows the nerve(s) time to heal.

Indications for Epidural Steroid Injections (ESI)

Healthcare providers may consider epidural steroid injections when other approaches, such as physical therapy or oral medications, have not provided adequate relief for some individuals. Results can vary.

ESIs may be considered for conditions such as:

• Herniated disc causing nerve compression and pain that may radiate to the arms or legs
• Degenerative disc disease, leading to reduced disc height and nerve irritation
• Spinal stenosis, narrowing the spinal canal, and compressing nerve roots.
• Radiculopathy from nerve root compression resulting in radiating pain such as sciatica
• Spondylolisthesis, where one vertebra slips over another, increasing pressure on nerves
• Post-laminectomy syndrome with persistent pain following spinal surgery
• Facet joint or nerve root cysts, pressing on spinal nerves and causing discomfort.

Epidural Steroid Injection (ESI) Procedure

Epidural steroid injections are used to help manage discomfort that may be associated with inflammation of spinal nerves.

The process involves careful preparation, precise medication delivery, and post-procedure monitoring to ensure safety and effectiveness.

Pre-Procedure and Medical History Review

• The healthcare provider assesses the patient's medical background, including current medications, allergies, and any existing health conditions.
• Patients must inform their provider if they are pregnant or using blood thinners, as adjustments may be necessary.
• Imaging tests like MRI or CT scans may be required to locate the affected area before the injection.
• Fasting may be needed for a few hours before the procedure, and patients should arrange transportation home if sedation is used.

What Happens During the Procedure

• Patients wear a medical gown and lie face down on an exam table.
• The injection site is cleaned thoroughly to reduce infection risk.
• A local anesthetic is applied to numb the area before inserting the needle.
• Imaging techniques like fluoroscopy or X-ray guide the needle placement for accuracy.
• A contrast dye may be used to confirm the needle is correctly positioned before injecting the medication.

How the Injection Is Administered

• Once the needle reaches the epidural space, a steroid medication, sometimes combined with a local anesthetic, is injected slowly.
• The provider applies light pressure to the site after removing the needle to prevent bleeding.
• A small bandage is placed over the area, and patients are monitored briefly before leaving.

Procedure Duration and Discomfort Levels

• The injection process typically lasts 15 to 30 minutes.
• Patients may experience mild pressure, tingling, or a brief burning sensation, but significant pain is uncommon.
• Some soreness at the injection site may persist for a few hours, and temporary pain flare-ups can occur before the medication takes full effect.

Who Performs the Procedure?

ESIs are performed by specialists with expertise in pain management and spinal procedures, including physiatrists, radiologists, anesthesiologists, neurologists, and surgeons.

Benefits of Epidural Steroid Injections

Epidural steroid injections help manage pain by reducing inflammation around spinal nerves. Potential benefits include:

• It can potentially provide temporary pain relief, and in some cases, the effects might last longer.
• By reducing pain, these injections may improve mobility and help some individuals perform daily activities more comfortably.
• They may help healthcare providers assess whether certain spinal nerves are contributing to discomfort.
• ESI might lessen the likelihood of needing more invasive treatments, potentially delaying or avoiding surgery.

However, the effectiveness of ESIs varies, and not all patients will experience these benefits.

Risks and Complications

Epidural steroid injections are commonly performed, but as with any procedure, there are potential risks and complications to consider.

• Headaches resulting from spinal fluid leakage, though this is uncommon and affects fewer than 1% of cases
• Low blood pressure may lead to dizziness or lightheadedness
• Infections such as epidural abscess, discitis, osteomyelitis, or meningitis
• Adverse reactions to medications, including skin rashes or hot flashes
• Bleeding issues if a blood vessel is affected, which might result in a hematoma or blood clot
• Nerve irritation or damage at the injection site
• Temporary loss of bladder or bowel control, sometimes requiring catheterization

Patients should review these risks with their healthcare provider to understand the possible adverse effects and complications related to their individual health profiles.

Recovery and Follow-Up After an Epidural Steroid Injection (ESI)

Some individuals may notice effects within 2-7 days, though responses vary. Pain reduction and improved mobility may last a variable duration, with some patients experiencing relief for several months.

Any unexpected reactions or side effects should be reported to a healthcare provider.

If there is no pain relief, it might suggest that the pain is not originating from the spinal nerves, requiring further assessment.

FAQs About Epidural Steroid Injections

Many people have questions about epidural steroid injections, from how long they provide relief to concerns about safety. Here are answers to some of the most common questions.

How long does relief last?

Epidural steroid injections may offer temporary relief for some individuals with a new disc herniation, though responses vary. For those with chronic pain or recurring disc herniations, relief may last for weeks to months, though the duration varies by individual.

How many injections can I receive?

Healthcare providers often recommend limiting epidural steroid injections to 3-6 injections per year, as frequent use could increase the risk of side effects and might reduce their effectiveness over time.

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Key Takeaways

• Epidural steroid injections (ESIs) may help provide temporary discomfort relief and support movement, though individual responses vary.
• ESIs may be considered for individuals experiencing discomfort related to conditions like herniated discs, spinal stenosis, sciatica, and degenerative disc disease.
• The procedure may ease pain, improve function, and delay or avoid the need for more invasive treatments like surgery.
• While generally safe, risks include headaches, infection, nerve damage, or adverse reactions to medication. It is crucial to discuss concerns with a trusted healthcare provider.
• ESIs are not a cure but can provide significant temporary relief, allowing individuals to regain control over their daily activities.
• Epidural steroid injections may not solve the underlying issue, but they can provide much-needed relief, enabling patients to live more comfortably and actively.
• Consult your healthcare provider about whether an epidural steroid injection is proper for you based on your specific condition.