Epidural corticosteroid shots (ESIs) can relieve excruciating long-term neck and back pain, help patients become functional again, improve quality of life, and in a lot of cases, they can reduce or eliminate pain indefinitely from spinal problems, according to interventional pain management specialist Kaliq Chang MD with Atlantic Spine Center.
What is epidural steroid injections?
“Individuals who opt to receive these epidural injections should make sure they are performed by a physician who is highly experienced in pain management, knows how to choose the best candidates for the procedure, and can maximize the safety and efficacy of the injections,” says Dr. Chang. He emphasizes that epidural steroid injections – ESIs – are not normally recommended until a patient has failed more conservative, nonsurgical measures to relieve pain, and says their effects do decline with time.
Experts concur. In a 2021 article published on the National Library of Medicine website Statistics indicate the number of ESIs performed in the United States tops nine million annually.
ESIs are generally used to relieve radicular pain – pain radiating to the legs from spinal nerves in the back and, less frequently, to the arms from nerves in the cervical spine – due to chronically irritated or inflamed nerve roots, Dr. Chang says.
Common causes of such inflammation are herniation of one or more intervertebral discs and a narrowing of the spinal or cervical canal (stenosis) where the nerves exit. Both are conditions that can result in nerve compression. When a disc bulges or avulses, the tissue may press against and pinch a nerve. Similarly, deterioration of the spinal or cervical bones from age-related osteoarthritis or other disorders contributes to stenosis by causing disc collapse, thickening ligaments in the area, or prompting the formation of bone spurs that can partially block the canals and impinge on nerves.
Fortunately, injecting anti-inflammatory corticosteroids, which are sometimes mixed with a local anesthetic, into the epidural space of the back or neck is a minimally invasive procedure, requiring only minutes to perform, Dr. Chang says. “Using fluoroscopy with contrast dye to guide needle placement and depth, the physician employs one of several techniques to insert the needle and deliver the medication to the proper location in the epidural space.”
The epidural space surrounds the protective covering of the spine and contains blood vessels, connective tissue, and nerves. When injected, the corticosteroids block pain signals coming from irritated nerves, minimize the body’s production of natural inflammatory substances, and suppress the chemicals that are released by damaged discs and that activate nerve fibers.
Patients with infections, malignancies, or bleeding disorders are not considered candidates for ESI. Additionally, “a physician may or may not proceed with an ESI if a patient has heart disease, uncontrolled diabetes, or osteoporosis,” Dr. Chang says. He cites an opinion article in the New England Journal of Medicine, in which the authors advise, “Patient selection may be the key to optimizing the efficacy of lumbar epidural steroid injection (for relieving neck and back pain), and we encourage the medical community to work to identify the types of patients who might benefit most.”
Back pain therapy
Optimal patient selection and safety are just part of the equation. Treatment usually starts with non-steroidal anti-inflammatory drugs as well as medication to control the pain. Physical therapy, rest, and activity modification should be all that is required to remedy the condition, although occasionally more aggressive treatment may be needed.
Epidural corticosteroid spinal injections for pain should be offered to patients as part of a “multimodal strategy” that includes exercise, healthy body weight, smoking cessation, and other lifestyle factors, Dr. Chang emphasizes. Such a combination of lifestyle changes constitutes a back pain therapy and treatment plan.
“ESIs are not magic bullets but can prove life-changing for the patient on a limited basis. They are second-line therapies offering temporary relief when more conservative measures like physical therapy, over-the-counter pain relievers, and muscle relaxants, do not fix the problem,” Dr. Chang says.
At Atlantic Spine Center, we may recommend lumbar epidural steroid injection as an initial back pain treatment, depending on the advancement of your condition. Epidural injection for back pain can help you feel more comfortable so that you are more likely to successfully progress during physical therapy.
Epidural steroid injections side effects
Even though epidural corticosteroid spinal injections for pain have many benefits, which will be covered later, this treatment also has some long-term complications. A permanent neurologic deficit can be caused by damage to the spinal cord or nerve root. This damage can be caused by epidural injection for back pain. The same spinal cord or nerve root damage can also result in chronic back pain.
In severe cases, when the blood creates a hematoma between the dura and spinal cord, a person can face permanent paralysis.
Risks and advantages of epidural steroid injections
There are numerous advantages of epidural steroid injections. They include temporary pain relief. This pain relief can help a patient participate in other treatment activities like rehabilitation exercises. Before such a procedure, a patient might not be able to perform them because of severe pain. Epidural steroid injections can reduce the need for invasive treatment options, so the chance of surgery is lower.
We’ve already covered some side effects of epidural steroid injections, but there are some more risks associated with this procedure. If you have low blood pressure, you can feel lightheaded after the procedure. Infection caused by epidural steroid injections can result in serious conditions such as epidural abscess, discitis, osteomyelitis or meningitis. If there was a spinal fluid leakage, a person will suffer from severe headaches. Among the short-term risks are a negative reaction to medications and temporary loss of bladder and bowel control.
The injections make bones and some muscles weaker, but most doctors limit the number of procedures per year.
Back pain prevention
Of course, the best insurance against pain is good spinal health. That is why Dr. Chang offers these tips for maintaining a healthy neck and back:
- Practice good posture when standing or sitting. Sit up straight. If standing for a long period, bend your knees slightly and place one foot in front of the other.
- Exercise regularly, focusing on the core muscles in the abdomen and lower back.
- Use proper lifting techniques, especially when picking up heavy or clumsy objects.
- Wear shoes that support the spine and keep the body in alignment.
- Lose weight. Obesity puts undue stress on the spine because the extra abdominal pounds pull on it.
- Sleep on a firm enough mattress.
To prevent many back conditions, you should maintain a healthy lifestyle and add some physical activity to your daily life. For example, you can perform special sciatica exercises that are beneficial for your back. Not only do they prevent back issues, but also they provide pain relief. With these exercises, the pain can ease for quite a while. Among other pain relieving options are those you can do yourself like putting ice or heat on the aching spot, and the ones your doctor can recommend. Prescribed and over-the-counter pain medications, epidural steroid injections, and physical therapy can be included in your pain management program.
Most importantly, if spinal problems do develop, closely follow your physician’s advice. An ESI may make you feel better, however, Dr. Chang says you can be active, but with caution. Your spine will thank you.