Lower back pain caused by sciatica is neuropathic, and the direct result of inflamed or damaged nerves in the lumbar portion of the spine. This inflammation can be caused in several different ways, but the first line of treatment is largely the same: identify effective methods for pain relief and pain management, and work to reduce the swelling.
In many cases of back pain, a specialized and individualized exercise plan, alongside over-the-counter medication, and physiotherapy can go a long way towards reducing or even eliminating lower back pain, or in the very least, slowing down its progression.
However, in cases of chronic pain, or where a gloomy prognosis looms in the near future, other more drastic measures might have to be taken into consideration to maintain a certain quality of life level and keep even the most mundane of activities from feeling like medieval torture.
One of the more effective ways of dealing with growing lower back pains that don’t respond to less aggressive treatment is an epidural steroid injection, particularly for cases of sciatica.
When applied correctly, an epidural steroid injection can greatly reduce pain and buy more time to allow a pain management team to work with a patient to combat their chronic pain issues in the long-term.
What Are Epidural Steroid Injections?
Consisting of a corticosteroid (medication that mimics the effects of cortisol, a stress hormone produced in the adrenal glands) and a numbing agent, an epidural steroid injection is a treatment aimed at flooding a portion of the spinal cord with medication that is meant to reduce swelling and numb pain.
The delivery of the steroid involves very carefully leading a large needle through the skin and tissue into the delicate sheath of the epidural space surrounding the spinal nerve. Highly accurate imaging technology is used to guide the needle and avoid perforating or damaging any nerves or bone tissue.
The procedure is quick and doesn’t take long to recover from. Limited side effects may present themselves after the injection, including spinal headaches.
However, it’s still an injection into the spine.
Certain risks need to be taken into account, and an epidural steroid injection should not be considered a first line treatment for back pain. If your doctor thinks it is a viable and very good option for long-term pain relief following a sudden and severe escalation of spinal pain caused by inflammation or compression, then it’s important to consider it.
Once recovery is complete, pain relief varies, but can last a shorter or longer amount of time.
The goal of the injection is to reduce pain long enough that when the medication wears off, the pain itself will have been permanently reduced or eliminated, either through rest or active treatment with a physical therapist specializing in chronic lower back pain and sciatica.
Does It Ease Sciatica and Lower Back Pain?
When you inject a corticosteroid into the epidural portion of the spine – which is the sheath surrounding the spinal nerve, or spinal cord, well-protected inside your vertebrae – you are flushing out the proteins that cause swelling in the area, and numb it to some of the pain you’re experiencing. Because sciatica is caused by a compression of the first sacral nerve and sciatic nerve in the lower back, reducing the swelling in that area also often reduces the pain.
However, it does not fix the issue at hand.
Sciatica can be caused by a degenerating disc, a herniated disc, bone spurs on the spine, or muscle strain compressing the sciatic nerve.
Treatment primarily includes rest and physical therapy, helping the body adjust to the condition and potentially rectify it by giving the issue enough time to resolve itself. What an epidural steroid injection essentially does is continue to buy more time for the heart of the issue to be solved through rigorous and individualized physical therapy and self-care.
Epidural steroid injections are not effective for every kind of back pain. They are effective for cases of:
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- Sciatica
- Spondylolisthesis
- Stenosis
- Degenerative disc disease
- Herniated discs
- Oher inflammatory conditions
Furthermore, these corticosteroid injections can also be the key to determining whether more invasive surgery may be required to fully help a patient overcome excruciating pain, by confirming the cause of the pain through the effectiveness of the injection.
How Effective Is It?
While epidural steroid injections can help for a variety of spinal conditions known to lead to lower back and leg pain, it’s also important to note that they’re not an effective solution for any type of back pain, or non-specific pain.
Medical professionals must still adequately and effectively monitor symptoms and potentially test with imaging technology to determine whether a steroid injection is a viable option for treatment.
Otherwise, it will have no effect.
In cases where it might help, an epidural steroid injection can provide pain relief lasting anywhere from a few weeks to several years, depending on many different factors. For patients with only mild relief, additional injections may potentially be scheduled.
Furthermore, it’s a good idea to optimize treatment around the injection, to ensure that once the medication wears off, other treatments will have helped to lessen the eventual return of pain.
Preparing for the Procedure
Epidural steroid injections are a little bit more involved than unceremoniously jabbing a patient, but it still isn’t a very long or complicated procedure, putting to rest any fears that might arise with treatments that can feel too risky as a result of their delicate and complex nature.
The first step is simply to identify the right area for injection, with the use of imaging technology (x-ray fluoroscopy). A local anesthetic and, optionally, a calming depressant can be used to help the patient relax and feel less pain as the injection is made.
Once positioned correctly, the go signal is given, and the proper medication is injected in the epidural space. After the needle is removed, patients are kept for observation and given over-the-counter pain medications for the injection site, if needed.
It only typically takes until the next day for a patient to fully recover from the injection, and up to a few weeks for the medication to become completely effective. It can take longer for the corticosteroid to kick in than it does for the numbing agent to wear off, so expect a slight spike in pain a few days after the injection.
When applied correctly, an epidural steroid injection can be just the thing you need for long-term, lasting relief, giving you the necessary advantage to push back against your pain and lead a better life.
