Epidural steroid injections are useful in the treatment of low back pain and pain in the legs or arms. Before having an epidural injection, you have to have had pain for at least 3 months. The pain should not have responded sufficiently to conservative treatments, including medications, maintenance of normal activities and physical therapy or chiropractic therapy. So called “red flag” conditions, such as infection, fractures and tumors should be ruled out. You will probably need to have imaging studies, such as X-rays, MRIs or a CT scan to help clarify what the problem.
Before we do an epidural injection, we perform a thorough history and physical in order to come up with a probable diagnosis and treatment plan.
Epidural injections place medications, usually local anesthetics and steroids, into the epidural space. The epidural space is a space outside of the dura. The dura is a membrane which surrounds spinal cord and the cerebral spinal fluid. By injecting medication into the epidural space, we can decrease the amount of pain that can arise from that area. There are many reasons why you can get pain which epidural injections can treat, including a disk protrusion, epidural scarring, changes after back surgery, or spinal stenosis from aging or other causes, just to name a few.
There has been some concern about using steroids. If you are concerned about steroids, you should know that epidural injections do not need to have steroids in them: you can have a safe injection with or without steroids.
We can perform epidural injections by one of three routes. Interlaminar injections are done between the lamina, or the bones which form the spinal canal in the back. Caudal injections enter the epidural space by the coccyx, or tailbone. And transforaminal injections come in by the foramen, where the nerve root exits.
We provide one epidural injection and see how you respond, both in terms of pain relief and also increased ability to do things and need less medicine. If you get partial relief, we might repeat the injection once. After two injections, we look to see if you have at least 50% relief for at least 6 weeks. If you do, we can repeat the injections up to four times a year, as long as you continue to get at least 50% relief for at least 6 weeks. All repeat injections require, of course, your approval. We do not routinely do three injections. We like to see you after every injection and make sure that you need another before proceeding.
If you suffer from back pain, and have tried other forms of treatment with no results, call the Helm Center today to set up a pain management consultation.