Epidural for Back Pain – Is It Good or Bad?

For treating pain in lower back and sciatica, Epidural Steroid Injections or ESIs are commonly used. Lumbar Epidural for back pain has been used since 1952 and is a pretty important part of managing lower back pain and sciatica non-surgically. Sometimes, just the shots are enough to relieve the pain but in certain cases, some rehab needs to follow the injection for better results. There are, of course, pros and cons to the procedure.

The following points will explain everything about Epidural Steroid Injections and what to expect from them –

How Long Does An Epidural Last?

Epidural for Back PainThe effect of these epidural injections is fairly temporary or can last from a week to even a year. However, when a patient experiences an acute episode of back pain or leg pain, using the injection can provide immediate recovery and relief. This relief would be sufficient enough for the patient to move forward with their rehab program and perform the necessary stretches. Usually, around 3 injections are used on a patient who finds relief with the first shot.

What Are The Other Areas For Which Epidural Steroid Injection Can Be Used?

Apart from being used in the region of lower back, pain in the neck or cervical pain and pain around the region of mid spine or thoracic can be eased using ESIs as well. In case of bulging disc, degenerative disc disease, disc tear or herniated disc, Epidural Nerve Block Injections are commonly used to relieve the pain. Also, when a woman is pregnant, epidural is given with a local anesthetic, but it has no effect on the baby and does not create any complications.

What Are The Benefits of Epidural Steroid Injections?

There has been a lot of debate on how effective Epidural Steroid Injections actually are. Their short term benefits are commonly known and discussed, but their long term benefits are still surrounded by much confusion. Also, there aren’t any studies convincing enough because they have not been performed properly.

The common methodological flaws in the studies include things like lack of verification of the medication’s proper placement because of exclusion of x-rays and fluoroscopy. Even though fluoroscopy is commonly used these days, this is still a problem. Also, while classification of patients is done as per diagnosis, proper methods are not followed, which makes the interpretation of results almost impossible.

However, Epidural Steroid Injections still have a lot of scope, and the following benefits cover them pretty well –

Focus On The Pain

With painkillers and steroids, the relief is always scattered because they don’t focus when they impact the target areas. Also, the side-effects of such medications are a lot as well. However, with epidural steroid injections, the exact area is targeted and relief is found.

Flush Out Chemicals

Pain is mostly caused by chemical inflammation, which also leads to swelling in the affected area. With Epidural Steroid Injection, it is possible to flush out the harmful chemicals like inflammatory proteins and relieve the pain and swelling substantially. This helps to control the pain and works well than other options.

What Is The Success Rate of Epidural Steroid Injection?

The success rates of the epidural injections are always dependent on a patient’s condition and the level of pain they have.

However, the benefits provided by them are substantial.

  • In cases where the placement has been properly done using x-ray or fluoroscopic guidance and confirmation has been obtained using contrast and radiography, more than 50% patients reported pain relief.
  • For leg pain (radicular), the review of Epidural Steroid Injections is better as compared to that with pain in the lower back.
  • The fact that Epidural Steroid Injection grants a patient more control over their mind cannot be overlooked. The patient experiences pain relief and is better able to avoid the use of painkillers. The patient can also avoid surgery or delay it for a long time because of these injections.

What Are The Risks Associated With Epidural Steroid Injections?

There is a certain amount of risk involved with all medical procedures and lumbar epidural is no different. However, the risks associated with ESIs are not commonly experienced, but they must be mentioned and should be discussed with the professional who performs the procedure to find out how prevalent they are.

The common complications include bladder and bowel numbness and the following –

Nerve Damage

In rare cases, Epidural Steroid Injections can cause nerve damage because of the needle that is in direct contact with the nerves. This damage can also be caused due to bleeding or infection in the lumbar region.

Bleeding

Patients with an underlying condition of a bleeding disorder should take note of this risk because it is common only in those patients. Otherwise, the complication is rare.

Infection

The incidence of getting an infection are 0.1% – 0.01% of the epidural injections that are used.

Dural Puncture

This is also called “wet tap” and 0.5% of epidural injections have an occurrence of Dural puncture. Issues associated with Dural puncture are spinal headaches or post Dural puncture headaches, but they only take a few days to improve. Sometimes, to relieve the headaches, a blood patch might be required. Basically, the procedure involves getting some blood from the vein of the patient’s arm. This blood is then injected into the epidural space so that it gets clot around the region of the spinal sac and the leak can be stopped.

What Are The Side Effects Associated With Epidural Steroid Injections?

Apart from the risks, there are many side effects from Epidural Steroid Injections. However, the same effects with oral steroids, which are much common, these side effects are also pretty rare, and they are as follows –

  • Patients could experience an increase in localized pain.
  • Sometimes, it is common to get non positional headaches, but they clear out after 24 hours
  • Flushing of the face is a common side effect after the injections.
  • Some patients experience sleeplessness and fever on the night the injection is administered.
  • Anxiety is a common side effect.
  • A high level of blood sugar could be reported by the patient.
  • The effect of steroids is suppressive, so some patients could experience a slow decline in their body’s natural immunity.
  • Stomach ulcers are another side effect.
  • There are chances of developing cataracts after Epidural Steroid Injections.
  • Another side effect, though uncommon, is severe arthritis in the region of the hips or avascular necrosis.

Usually, ESIs are covered by insurance and could cost $2000 for every injection. Around 3 injections a year are required to completely eradicate the pain.

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