This is where the technologist operates the scanner and monitors your exam in direct visual contact. The technologist will be able to hear and talk to you using a speaker and microphone. The different types of medications injected into the epidural space create different effects for patients. Corticosteroids act as anti-inflammatory agents, reducing swelling and nerve irritation to allow the nerve time to heal itself, thereby preventing further discomfort.
By delivering an epidural injection directly into the epidural space, the medication moves throughout the epidural space, coating the inflamed or irritated nerve roots.
Therefore, a lumbar lower back injection could alleviate pain associated with the lower back and the nerves traveling to the lower limbs, such as the sciatic nerves.
Similarly, if an epidural injection is performed in the neck, it should spread throughout the cervical epidural space and provide relief to nerve roots in the neck which can also relieve arm pain. See the Facet Joint Block page for more information. The duration of improvement from the epidural injection varies. Some patients have permanent relief. In others, the effects may not last long. In some cases, you may have a series of injections before you may benefit from significant relief.
A patient may experience relief for a matter of days up to several months; however, the pain may eventually return, requiring another series of injections or an alternative treatment. This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted. The epidural injection usually takes only minutes to administer, but positioning in the CT or x-ray unit may take longer.
When you arrive at the office, hospital or surgical center, the nurse or technologist may place an intravenous IV line in your arm to deliver a relaxation medication during the procedure; this is seldom needed but will be available if required. You will be situated on your stomach or on your side, on a table in the fluoroscopic room or in a CT scan room and made to feel as comfortable as possible.
The doctor will identify where the injection should be given and will clean and sterilize the skin with an antiseptic solution. A local anesthetic is then injected to help numb the area before administering the epidural injection.
Once the area is numb, the doctor will most likely use imaging guidance to help guide the epidural needle to exactly the right position. When the needle is in place, a contrast material will be injected so the doctor can accurately target the nerves for sufficient distribution of the medication. When finished, you will be moved into a chair or bed and allowed to rest for a few minutes to an hour. The nurse or technologist will make sure you do not have any unfavorable reactions to the medication before you are allowed to leave.
You may have no sensation whatsoever, however you may feel tingling or pressure when the injection is administered. Depending on the amount of swelling in the area, you may experience a burning sensation at the site or in your upper or lower extremities or some mild discomfort as the medication enters the epidural space. When the injection is finished, however, any discomfort usually disappears.
It is also possible to feel "pins and needles" in your arms and legs, depending on the injection site. If you feel any sharp pains, however, tell your doctor immediately. Due to the numbness and any discomfort you may experience after the procedure, you may have some difficulty walking on your own and getting in and out of the car.
This is normal and should subside in a matter of hours. You should take it easy for the rest of the day, though, and may resume normal activities the next day. The epidural may not take effect immediately—it is common for improvement in the pain to occur progressively over the first 48 hours.
The effects may last for a matter of days, weeks, and occasionally months. In some patients, the pain may initially feel slightly worse before it starts to improve.
It may also be necessary to have a series of epidural injections to fully improve. A radiologist or anesthesiologist will most likely perform the epidural injection, however, a neurosurgeon, orthopedic surgeon, or neurologist may also administer it. The doctor who delivers the injection will follow up with you to see how you are doing and determine if further action is required.
Any imaging that is performed during the procedure itself will conclude with the procedure, and no follow-up image interpretation is necessary. This visit may include a physical check-up, imaging exam s , and blood tests. During your follow-up visit, tell your doctor if you have noticed any side effects or changes. Women should always tell their doctor and technologist if they are pregnant. Typically, if the initial injection is effective, up to 3 injections may be given in one year.
When administered in the lumbar epidural space, steroid injections may have the following benefits:. This type of injection can provide acute and significant pain relief because it introduces a steroid medication with strong anti-inflammatory effects directly into the painful area near the spinal nerve s. An epidural injection may be given using any one of the following approaches:. View the various routes used in an epidural steroid injection: Transforaminal, Interlaminar and Caudal.
Typically, up to 3 injections may be given over a month period. While many studies have documented the short-term benefits of epidural steroid injections, the data on long-term effectiveness are less convincing. Controversy persists regarding their effectiveness in reducing pain and improving the function. Literature both supporting and opposing them are available. These methodological flaws tend to limit the usefulness of the research.
More studies are needed to define the role of epidural steroid injections in lower back pain and sciatica. Most common lower back conditions treated include 1 :. Less commonly, localized back pain axial back pain and neurogenic claudication back pain and leg pain that occurs while walking may be treated with these injections. Doctors who administer this type of injection include spine and pain management specialists, such as physiatrists, anesthesiologists, radiologists, neurologists, and spine surgeons.
The injection procedure typically takes place in a surgery center, hospital, or a physician's clinic. Epidural steroid injections are considered a relatively safe and minimally invasive. Temporary side effects may occur in some cases and include but are not limited to :. These side effects typically resolve in a few minutes to hours. In general, epidural injections administered for spinal levels L4 or lower carry a lesser risk of complication s compared to higher levels.
The injections are typically not given when certain complicating medical conditions are present, such as infections, tumors, or bleeding disorders. Additionally, the injections may not be given in case of uncontrolled diabetes mellitus, certain heart conditions, and pregnancy. The treatment area in the lower back is numbed with a local anesthetic injection before the epidural is given, so the epidural injection procedure is usually painless.
If you receive medicines to make you sleepy during the procedure, you must arrange for someone to drive you home. ESI provides short-term pain relief in at least one half of the people who receive it. Symptoms may remain better for weeks to months, but rarely up to a year. The procedure does not cure the cause of your back pain.
You will need to continue back exercises and other treatments. Dixit R. Low back pain. Philadelphia, PA: Elsevier; chap Interventional nonoperative management of neck and back pain. Benzel's Spine Surgery. Narayan S, Dubin A. Nerve blocks: spine. Pain Management Secrets. Updated by: C. Editorial team.
Epidural injections for back pain. ESI is done in a hospital or outpatient clinic. The procedure is done in the following way: You change into a gown.
You then lie face down on an x-ray table with a pillow under your stomach. If this position causes pain, you either sit up or lie on your side in a curled position.
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