Epidural Steroid Injections
Epidural Steroid Injections need to be deconstructed to be better understood. It sounds heavy and ominous, but it’s actually a minimal step that provides large benefits. While most people have used and heard all three of those words individually, they may not have heard them joined together. An Epidural Steroid Injection (ESI) is a commonly used treatment for sciatica and lower back pain. They are ideal for radicular pain (pain that occurs when the pain radiates from an inflamed or compressed nerve). The injection delivers steroids directly to the epidural region of the patient’s spine. The physician may use additional fluid with the steroid such as an anesthetic or a saline solution to help flush out any additional sources of pain in the epidural region. The nerves in the epidural region travel to the mid back and along the body’s ribs. Any type of inflammation can be caused by damaged discs or any damage done to the bony structure of the spine, and the injection shrinks this inflammation.
An additional benefit to the injection is that it gives the patient time. If the initial injury can be healed with physical therapy, but you’re in too much pain to even attempt it, the injection can provide enough relief to start. Once relieved from the pain, the patient is able to begin their mild exercise regimen in order to complete the healing process. The patient may even have back surgery planned, but they need to delay it. Instead of living in misery till their surgery, a patient can discuss getting ESI’s with their physician to give them some buffer time before their surgery date.
The nerves within the region are then bathed in the steroid and anesthetic, inhibiting the pain from being able to radiate. Depending on the source of the pain, there are three “locations” for the injection as well: cervical, thoracic, and lumbar. The cervical region is located roughly in the top third of the spine, thoracic in the middle third of the spine, and the lumbar in roughly the lower third. The source of the pain will determine the injection site for the ESI. The benefit of this injection allows for a concentrated attack of the source of the pain, as opposed to oral steroids and painkillers that are dispersed through out the body and not concentrated. The entire process, from start to finish may take 15-30 minutes, and you will need a driver to take you home. Sedatives are rarely necessary, and the injection itself should not be uncomfortable. Once home, it is recommended you don’t do any strenuous activity, and your diet can return to normal. It’s important for a patient to listen to their body, and monitor any changes, positive or negative. Ideally, a patient maintains a “pain diary” where they can record procedures and medications that have worked, and others that haven’t provided relief. Ultimately, the patient should discuss the type of ESI and spinal cord stimulation that would be most appropriate for them and then enjoy it’s results.