What You Need to Know about Epidural Spinal Injections
Ninety percent of American adults will experience an episode of back pain during their lifetime, says Daniel Mazanac, MD, Associate Director for the Cleveland Clinic Center for Spine Health. Back pain can come from a variety of causes including injury, structural problems, arthritis, poor posture and stress, and can interfere with an individual's work, home, sleep and relationships. Before a doctor considers spine surgery to relieve a patient's symptoms, he or she will most likely recommend one or more non-surgical treatments. An epidural spinal injection may be one of these treatment options.
An epidural spinal injection, also known as an epidural steroid injection, is a non-surgical treatment for radiating back pain that may provide either short or long-term relief, anywhere from a week to several months. Epidural spinal injections are most commonly used for conditions such as spinal stenosis, disc herniation, and arthritis in the facet joints of the spine.
What are the Pros for an Epidural Spinal Injection?
When other treatment methods have failed to relieve your back pain, an epidural spinal injection may block or lessen your pain considerably, allowing you to fully participate in a rehabilitation program to treat your symptoms for the long run.
How Does an Epidural Spinal Injection Work?
An epidural spinal injection involves delivering anti-inflammatory medication--typically a steroid combined with an anesthetic--directly into the area around the irritated spinal nerves that are causing the pain. This area (called the epidural space) surrounds the protective membrane that covers the spinal nerves and nerve roots. The steroids inhibit production of the proteins that cause inflammation, and thereby reduce nerve irritation in the patient; and the anesthetic blocks nerve conduction in the area where it is applied, numbing the patient's sensation of pain.
An epidural spinal injection is generally done on an outpatient basis, either at a doctor's office, medical center or local hospital. The procedure typically takes 15-30 minutes. After the procedure, the patient is monitored for about 30-60 minutes in the recovery room. From there, the doctor will have specific after-care instructions for the patient to maximize their recovery, which may involve a rehabilitative program such as physical therapy or yoga.
How Will I Feel After The Injection?
After you receive an epidural spinal injection, you may experience some numbness in your arms or legs temporarily (typically 1 to 8 hours) as a side effect of the anesthetic component of the injection. Your pain may also increase over the following 24-48 hours. It generally takes 24-72 hours for the pain-relieving benefits of a epidural spinal injection to take effect.
How Often Can I Get An Epidural Spinal Injection?
Most doctors do not believe that repeated and frequent epidural spinal injections are a good way to manage back pain over the long term. Most doctors limit the number of injections they will give within a certain period of time to reduce the risk of potentially serious side effects. Three per year is the common guideline.
What Are the Potential Side Effects?
The common side effects include:
- Decreased bone density
- Thinning skin
- Weakened muscles
- Decreased production of naturally occurring steroids
It's important to note that an epidural spinal injection is typically not considered a cure for back pain, but rather a treatment tool that a doctor can use to help ease a patient's pain and discomfort as the underlying cause of the problem is being addressed through a rehabilitative program, or while the patient is considering surgical treatment options.
What are the Risks Associated with Epidural Spinal Injections?
As with any procedure, there are always certain risks involved. Before deciding on an epidural spinal injection, consider these risks:
- Bleeding or infection at the injection site
- Pain during or after the injection
- Post-injection headache
- Reaction to injection medication
- Nerve injury, including spinal cord injury and quadriplegia
- Bladder dysfunction
- Fluid retention
- Respiratory arrest
- Epidural hematoma (a collection of blood outside a blood vessel caused by a leak or injury)
- Spinal cord infarction (this occurs when one of the three major arteries that supply blood to the spinal cord is blocked)
If you are experiencing back pain, and are not sure if an epidural spinal injection is the right choice for you, consider the following options as possible tools to help you with back pain relief.
Alternative Options for Back Pain Relief
Exercise/Physical Therapy. Exercise may be the most effective way to speed recovery from low back pain and help strengthen surrounding muscles to prevent future injury or pain. Ask your doctor or physical therapist to provide you with a list and/or demonstration of appropriate exercises.
Acupuncture. Several studies on the use of acupuncture in people with chronic low back pain have shown that acupuncture provides definite pain relief in the short term and potentially over the long term. Ask your doctor for a recommendation.
Biofeedback. Chronic back pain has been associated with a range of physical, emotional and psychological elements. The goal of biofeedback is to teach the patient how to control his or his response to pain, and how to enter a relaxed state in which he or she can better cope with pain.
Massage. Some studies have shown strong evidence of the positive benefits of massage in treating chronic low back pain. Massage can relieve muscle tension and stress, promote relaxation, and improve circulation and range of motion of the back. Note that massage isn't advisable for people with unhealed fractures, rheumatoid arthritis in the area to be massaged, severe osteoporosis, deep vein thrombosis, skin infections or open wounds.
Yoga. Studies of adults with chronic low back pain have found that a gentle yoga routine is as effective as pain medication in reducing pain. Note that some yoga postures might be too strenuous for your low back, and therefore it is important to work with a trained instructor who can advise you on appropriate postures to care for your back.
Note: It's important to carefully weigh the potential risks and benefits of epidural spinal injections for your situation. Talk to your doctor thoroughly about all treatment options before making your decision.
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Erstad, S. Epidural steroid injections for lumbar spinal stenosis. YahooHealth.com. February 21, 2008. http://health.yahoo.com/back-medications/epidural-steroid-injections-for-lumbar-spinal-stenosis/healthwise--uh1944.html. Accessed January 11, 2010.
Low Back Pain Fact Sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed January 11, 2010.
Mayo Clinic Staff. Back Pain Guide: Other Invasive Treatments for Back Pain. MayoClinic.com. http://www.mayoclinic.com/health/back-pain-treatment/BA99999/PAGE=BA00012. Accessed January 11, 2010.
Mazanec, D. Managing Back Pain. Cleveland Clinic. November 10, 2008. http://my.clevelandclinic.org/multimedia/transcripts/mazanec_back_pain_transcript.aspx. Accessed January 11, 2010.
Non-Surgical Treatments for Back and Neck Problems. SpineUniverse.com. http://www.spineuniverse.com/displayarticle.php/article3501.html. Accessed January 11, 2010.
Swanson, J. Epidural Steroid Injection for Back Pain: Why limit dosing? MayoClinic.com. http://www.mayoclinic.com/health/epidural-steroid-injections/AN01892. Accessed January 11, 2010.
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