While chronic pain is common, most adults have it either in the back, hips, or knees. Of the three, the lower back takes the most blame for pain problems, often originating with some form of inflammation or injury in the spine. Usually, it’s a combination of age and stress, and sometimes, it’s a genetic issue or the result of a different illness. Chronic pain has been a problem for as long as we can remember, yet its only in the past few decades that we’ve taken a proactive approach towards treating pain as a disease when it becomes a debilitating issue. While pain can teach us what to avoid and how to stay alive, it can also keep us from living given the right circumstances and attributes. One of modern medicine’s greater challenges is helping individuals of all ages and sizes better avoid and address their pain.
One of the ways in which doctors stop or slow the growth of pain throughout the back is through epidural steroid injections (ESIs). These are a common treatment option for some people who struggle with lower back and leg pain, including disc herniation, bulging discs, and sciatica. Unlike certain other treatments, the idea behind an epidural steroid injection is not necessarily to remove the cause of the pain, but to relieve the pain. It’s used in conjunction with other treatment methods – including extensive rehabilitation – to help put an end to lower back pain.
What Are Epidural Steroid Injections?
By injecting a steroid into the epidural space of the spinal cord, doctors can essentially push the body to quickly resolve inflammation and fight off a source of back pain very quickly. Often times, back pain comes from pressure on the nerve roots and the spinal cord in the spinal canal, which causes said nerves to become inflamed and very painful. This can radiate down the leg and throughout the back, making it difficult to walk without pain. Depending on the origin of the pain, many people with these sorts of spinal problems may even struggle to sleep or stand.
The spine is a series of bones called vertebrae, stacked on top of each other alongside spongey discs. Running along the spine is the spinal cord, as well as a complex series of nerves connecting your entire nervous system with the brain, up inside the human skull. The spine is segmented into the cervical spine (neck), thoracic spine (upper back), lumbar spine (lower back) and coccyx (tailbone). The spine curves lightly in an S-shape, and it designed to move, compress, decompress, and allow for all sorts of mobility. Connected to the spine and the nerves of the spine is every muscle in the human body, responsible for our mobility and conscious movement.
The lower back is most susceptible to injury because it’s longer than the neck (which can also often be injured), and because it’s more often put under an inappropriate amount of shearing forces (when lifting a heavy object, for example. Furthermore, circulation to the lower back can be terrible at a certain age. Unlike the upper back, which is protected through a larger series of muscles as well as a ribcage, the lower back is also prone to being flexed or bent quite often, especially when be move to pick something up, hunch over, or crouch down.
Injuries happen in many different ways, and epidural steroid injections can help tremendously in a wide variety of spinal problems – but not all of them. There are times when ESIs are inappropriate, and times when they can massively improve quality of life.
How Are ESIs Done?
An ESI begins with the patient on their stomach, on an x-ray table. A separate needle is used to administer a local anesthetic, and potentially, an oral sedative is offered as well. The patient is typically awake throughout the procedure. The anesthetic is simply to minimize discomfort, while the sedative is to help a patient remain calm.
Next, with the aid of x-ray imagery, a different needle is used to enter the epidural space. The dural sac is a sac of fat and blood vessels within the spine, between the vertebrae. The procedure must be perfectly precise, and progress is made slowly, to ensure that everything goes right the first time. Failure to inject the right treatment site may lead to a second attempt, but the more attempts a patient has to endure, the higher the chances are of a complication – that’s why x-ray imagery is crucial to getting it right the first time. As one can imagine, the feeling of a needle in the spine isn’t pleasant even with an anesthetic, but it’s quite quick, nonetheless.
ESIs can be applied anywhere in the spine, most often in the lower back and neck. The spine is injected from the side rather than straight ahead, and if more than one side is inflamed, a doctor may make several injections.
What Kind of Steroids Are Used?
The ESI involves a corticosteroid (also known as cortisone steroids, or cortisone shots), and an anesthetic numbing agent. Some corticosteroids that may be used include:
- Triamcinolone
- Methyl-prednisolone
- Dexamethasone
- Prednisone
- Hydrocortisone
- And more
These steroids stop and reduce inflammation by helping flush out the proteins that cause nerves to swell. This can drastically reduce pain but won’t address the root issue. Instead, epidural steroid injections are used as one among several steps to address and stop a patient’s back pain.
What Could Go Wrong?
Epidural steroid injections are much less invasive than surgery, but they still possess some risks. Because you’re entering into the spine with a needle, there is a risk of damaging the nerve or some other complication arising during or after the procedure. Certain complications can lead to paralysis or nerve damage. In cases where a patient doesn’t fully disclose their medical history or if an allergic reaction to a specific steroid isn’t known, they may react allergically to the injection. Bleeding infection, and a spinal headache are all possible side-effects after any injection to the spine.
Some of these are quite rare, and they’re not very likely to happen. It’s also recommended that patients completely disclose all medication and drug use, so doctors could make a recommendation as to what to stop taking for how long before the procedure. For example, anti-clotting medication should be discontinued temporarily before an ESI.
When Are ESIs Helpful?
ESIs are helpful when surgery is not necessary, and when a patient can be treated through regular and rigorous physical therapy, but still requires medical intervention to raise quality of life to the point where physical therapy becomes a realistic option.
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