“You want to stick a needle near my spine? No way !” That’s the reaction Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center, sometimes hears from patients when he and colleagues suggest epidural steroid injections (ESIs), an effective first step for relief from many causes of back and neck pain. But some of these knee-jerk reactions are fueled by myths and misconceptions about the established treatment, not the facts, Dr. Liu says.
“Epidural steroid injections are actually quick, simple and safe procedures for patients with back or neck pain with radiating arm and leg pain,” says Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. “People’s fears far outweigh the actual risks of the treatment, which are minimal. Once I talk to patients and inform them about what’s really involved in epidural steroid injections – and what the benefits are – many realize that they want to give them a try.”
Just the facts
So, what is involved in getting an ESI? The procedure delivers a long-lasting steroid – a medication known to reduce pain-triggering inflammation – as well as a local anesthetic to the epidural space around the spinal cord. Used as low back pain treatment for more than 60 years, the injections are done using “live x-rays” known as fluoroscopy to verify the proper placement of the needle delivering the medication.
Who may be eligible to undergo an ESI? The treatment can help those with the following conditions:
- Radicular pain, also known as sciatica, which radiates from the site of a pinched nerve in the neck or lower back.
- Lumbar disc herniation, where the contents of the disc push through the outer ring into the spinal canal, pressing on the spinal cord and surrounding nerves.
- Lumbar spinal stenosis, a narrowing of the spinal canal that squeezes off nerves and the spinal cord, causing leg pain.
- Annular tears, where a tear in the outer layer of a disc causes pain.
The injection itself takes 15 to 30 minutes, with patients able to go home shortly after the procedure and resume normal activities the following day. The steroid usually begins to work within 1 to 3 days, greatly reducing pain that, in some cases, has consumed patients’ lives and left them unable to take part in their favorite activities.
“This non-surgical procedure, which can be repeated up to 3 times per year, often helps patients avoid more invasive procedures,” Dr. Liu explains. “Although steroids don’t change the underlying back or neck condition, they can break patients’ cycle of pain and inflammation. Epidural steroid injections have become an extremely valuable tool in our arsenal of pain treatments.”
Tips for understanding the benefits
Patients often carry many myths and misconceptions about ESIs, greatly inflating their potential risks, Dr. Liu says. But while no medical procedure is without risk, the actual risks from epidural steroid injections are minor. Some patients may experience a headache afterwards, a so-called steroid flush of the face and chest, anxiety, trouble sleeping or even a low-grade fever.
Dr. Liu offers these tips to understand how ESIs can benefit patients:
- Unlike oral painkillers, the injections deliver medication very near the source of back or neck pain. “Pills have a dispersed, less-focused impact and may come with nasty side effects,” he says.
- ESIs control inflammation near the spinal cord while also “flushing out” inflammatory chemicals that can accumulate around the area and worsen pain, he says.
- ESIs also work by reducing the immune system’s response to inflammation associated with nerve or tissue damage.
“When performed by an experienced doctor using x-ray guidance, epidural steroid injections are highly safe and very well-tolerated,” Dr. Liu notes. “Any side effects are generally fleeting and patients’ feeling of overall well-being from the resulting pain relief lasts much longer.”