When is an Epidural Injection Appropriate for Back Pain?

Epidural InjectionTreatment

Learn which back problems can benefit from epidural treatment.

If you hear the word “epidural” and think of pain relief for women giving birth, think a bit bigger:

Epidural steroid injections have been a tried-and-true treatment for chronic back pain since the early 1950s, according to Endoscopic Spine Surgeon Kaixuan Liu MD, PhD., founder, and medical director of Atlantic Spine Center.

One of the most prevalent procedures doctors perform for low back pain, epidural injections are done about 9 million times each year, Dr. Liu explains. This important option is high on the list of effective treatments for those with chronic back or neck pain, which also includes exercise, physical therapy and medications.

What Is an Epidural Steroid Injection?

An epidural steroid injection (ESI) is a medical procedure in which a corticosteroid medication is injected into the epidural space, which is the area around the spinal cord and the nerves that exit it. This type of injection is typically used to reduce inflammation and pain in the spinal region, including the lower back, neck, and legs.

Delivered to the epidural space in the spine, each epidural injection blends two substances: a local anesthetic, which interrupts pain signals from the spinal area; and a long-lasting steroid to reduce inflammation and irritation in the region it’s injected.

“It takes only minutes to do, but an epidural steroid injection can relieve lingering back or neck pain lasting months or longer,” Dr. Liu says. “It’s well worth the small investment of time involved.”

What Back Conditions Can Benefit from Injections?

A long list of back problems can benefit from epidural injections, Dr. Liu notes. What do they all have in common? “In general, these conditions squeeze or irritate nerves radiating from the spine,” he says.

They include:

  • Sciatica, pain radiating down one or both legs from the lower back
  • Herniated discs in the lumbar (lower back) area, where the soft center of a disc pushes through its hard shell and into nerves in the spinal canal
  • Spinal stenosis, a narrowing of the spinal canal that pinches nerves in the spinal cord
  • Degenerative disc disease, where a collapsed disc space presses on nerves
  • Compression fractures, when one or many bones in the spine weaken and break
  • Cysts in spine joints or nerve roots
  • Annular tears, where tears form in a disc’s outer layer

Since this list of back conditions affects many thousands of patients each year, epidural injections are an option for a large proportion of back and neck pain patients, Dr. Liu says. “These injections not only can provide quick relief on their own, but they also promote exercise, stretching and other activities that help patients improve even more,” he adds.

How Epidural Injections Are Given?

You might be wondering just how an epidural for back pain is given. No trepidation is needed, Dr. Liu says, since the process is simple and quick. First, you lay on your belly on an X-ray table. The skin closest to the injection site will be swabbed with an anesthetic to numb the area.

Using fluoroscopy, a “live X-ray” technique, to view the area surrounding your spine, your doctor injects the steroid mixture into the epidural space near where your pain originates. Within 30 minutes – part of which will be used to monitor you after the injection – you can go home, Dr. Liu explains.

You’ll be encouraged to rest for the remainder of the day, but can resume normal movements and activities the following day. Depending on your results, you may benefit from repeating the injection several weeks later, Dr. Liu says, while three epidural injections are generally considered reasonable within six months.

Epidural Steroid Injection Risks

The effects of lumbar epidural steroid injection may vary depending on the individual and the condition being treated. Some patients may experience immediate relief, while others may need several injections over time to achieve significant pain reduction. Common side effects of the procedure may include temporary numbness or tingling, headache, or mild discomfort at the injection site.

Epidural steroid injections are generally considered safe, but as with any medical procedure, there is a small risk of complications, including infection, bleeding, or nerve damage. Therefore, it is important to discuss the risks and benefits of an epidural steroid injection with your healthcare provider and to follow their instructions carefully both before and after the procedure.

In summary, an epidural steroid injection is a minimally invasive procedure that can provide relief from pain and inflammation in the spinal region. Proper preparation and monitoring can be a safe and effective treatment option for many patients.

“Before your doctor would ever consider invasive surgery to alleviate your back or neck pain, epidural steroid injections would be one of the key conservative treatments tried,” Dr. Liu says. “In most cases, this minimally invasive option works extremely well and makes a true difference in patients’ quality of life.”