FAQs on Epidural Injection
Safe and highly successful, epidural injections are now widely used to get relief from debilitating neck and back pain. These steroid injections become hugely popular within decades of their invention in the 1950s and continue to be effective with more than 75 percent cervical and lumbar pain relief on an average. Epidural injections assure semi-permanent relief from radicular pain and the success rate can be as high as 95 percent if combined with conservative treatment over an extended period.
What is epidural injection?
The pain relief injection derives its name from the epidural space located between the boney spinal column and the dura mater around the spinal cord. This is the very place where spinal nerves come out of the spinal cord. Epidural injections are delivered around the nerve exits to inhibit pain caused by nerve root inflammation or irritation.
What are medical conditions treated with epidural injections?
Patients with following conditions are likely to get significant pain relief from epidural injections.
- Chronic neck and back pain
- Lower back pain
- Painful conditions associated with spinal stenosis, spondylitis, herniated disc problem, degenerative disc, nerve impingement, bulging disc, slipped disc
- Pain following nerve root compression or radiculopathy
- Pain due to inflamed nerve root or radiculitis
- Bilateral radicular pain
- Radicular cervical or lumbar pain
- Sciatica or leg pain
- Pain originating in intervertebral discs
How do epidural injections provide relief?
Medication injected by epidural injections soothes the irritated or inflamed nerve root, which is responsible for radiating pain. Pinching of nerve roots attributed to herniated or bulging vertebra discs results in pain inflammation and pain that gradually spreads to nearby areas.
By soothing inflamed nerve roots and numbing the pain-originating area, corticosteroid medication in these injections ensure significant pain relief over an extended period. It allows inflamed nerves to recover while subduing the pain signals.
How effective are epidural injections?
- There are several research studies showing 75 to 90 percent efficacy of epidural injections in ensuring neck and back pain relief.
- Epidural injections are as effective as surgery when there is pain with sciatica attributed to herniated disc problem. (The Journal of the American Medical Association report)
- In case of cervical radiculopathy, these injections are found to be 72 percent effective in relieving pain. (Skeletal Radiology, 2007)
- Epidural injections are helpful in inhibiting symptoms of radiating lumber back pain. (Pain Physician, 2007)
- Spinal stenosis-related bilateral radicular pain reduces considerably and patients experience significant improvement after having epidural injections. (Journal of American Academy of Orthopedic Surgery, 2007)
Who is a suitable candidate for epidural injections?
Any one suffering from acute radicular pain in neck, back and leg and who does not have significant relief despite using other conservative therapies and medications can go for epidural injections. However, those allergic to anesthetics or steroids, with high diabetes or suffering from ongoing infections are advised against having the treatment.
What is injected through epidural injections?
Epidural injections have a mixture of steroid and local anesthetic, such as lidocaine. The local anesthetic numbs the nerve roots and inhibits pain signals. The steroid treats the inflammation and prolongs the effect.
What are various types of epidural injections?
Epidural injections are of three types depending on their process of administration.
- Transforaminal injection allows best possible pain relief and is the most popular method. The medication is delivered from either side ensuring more precise delivery of medication.
- Intralaminar epidural injections are used to have short term pain relief. These injections are delivered in between two vertebrae from the top directly to the epidural space. However, no guarantee that the medication reach the frontal space of nerve roots. Used when transforaminal process is not an option.
- Caudal injections are delivered using a catheter inserted from the tailbone side. This brings relief to a group of inflamed nerves caused by spinal stenosis, but lacks strong localized effect
How is an epidural injection administered?
Doctors may administer an intravenous sedative to ensure that the patient is relaxed, though its use is subject to discretion. The skin above the pain and soft tissues around are numbed with a local anesthetic.
A needle is injected to the pain spot under real-time x-ray guidance. First, dye is used to ensure the perfect placement of the needle. Then, the medication, a combination of lidocaine and a steroid, is delivered to the epidural pace.
How long an epidural injection takes?
An epidural injection is administered in 15 to 30 minutes.
How do I feel after having epidural injections?
Epidural injection treatment is done in an outpatient setting and patients are discharged within hours after a brief observation. It is better to take rest for the rest of the day and do activities as you can tolerate. There may be numbness or inflammation on the injection site.
Is there any precaution required?
Patients need to lie prone or on the side during the medication delivery. They have to rest in a supine position or sit for an hour after the procedure. Use ice pack on the injection site. Avoid heat.
When can I expect pain relief?
Patients experience pain relief immediately after the procedure. You can observe pain relief while doing your daily activities after 24 hours.
How long the impact lasts? How many epidural injections do I need?
The duration of pain relief vary from patient to patient. It can be between a few weeks and a few months depending on patient condition. Patients with acute pain can have a series of three injections in six months to achieve better results. The exact number of epidural injections and the time gap is decided in consultation with the doctor.
What are side effects of epidural injections?
Injection-site soreness or inflammation may be there for up to 48 hours. There is no major side effect when administered by an expert using fluoroscopy. Otherwise, it may cause rupture of blood vessels and nerve and soft tissue damage.