These injections are performed by guiding a long syringe into the epidural space between the spinal cord and the spinous process of the vertebrae, hence the name. The actual medication used when performing an epidural injection depends on the purpose of the treatment, and the condition being treated.
Because epidural injections always target the spine and its surrounding nerves, they can be used to help treat back pain. But it isn’t a panacea, either. Some back pain isn’t treated best by an epidural injection – and there are times when the injection might help soothe the pain but doesn’t address the root cause.
What Are Epidurals?
Epidural injections or epidural nerve blocks utilize different chemicals and medications to provide either short-term or longer-lasting pain relief for patients, by targeting specific portions of the spine.
The process is performed by guiding a syringe into the epidural space of the patient’s back utilizing imaging technology, such as fluoroscopy. A little local anesthesia helps minimize the pain of the injection. This is similar to a spinal tap or lumbar puncture, although, in the case of an epidural, the needle doesn’t travel quite as deep into the spine.
Epidural injections or nerve blocks utilize either a painkiller or a corticosteroid to cut off pain signals leading to the brain or reduce swelling associated with nearby herniated discs. Epidural injections can be used to:
- Provide local anesthesia.
- Block nerve signals of the surrounding nerve roots.
- Temporarily cut off all sensory and motor neurons from below the injection site.
- Reduce swelling and inflammation in a target area.
An epidural is one of multiple different non-invasive, non-surgical interventions a doctor may bring up before talking about surgery for back pain.
In most cases, surgical interventions are considered a last resort, when all other options have been exhausted. An epidural may be a step up from anti-inflammatory medication and ice packs but is still less dangerous than a long-time opioid prescription or an unnecessary surgical intervention.
When Do Epidurals Help?
Not all examples of back pain can be helped through an epidural injection. An epidural specifically targets the nerves and tissue surrounding the injection site, cutting off pain signals or reducing swelling and inflammation. If your back pain is the result of a pulled muscle, then it’s unlikely that an epidural injection will be the best course of treatment.
Likewise, if your back pain is caused by a bone spur or an abnormal growth surrounding nearby nerve roots, then it might provide temporary pain relief, but will otherwise just delay an inevitable surgical or alternative intervention.
Examples of conditions where epidurals may be suggested by your doctor include:
- Degenerative disc disease
- Disc herniation
- Temporary pain relief during labor
- Targeted anesthesia for certain back surgeries
- Pain relief for post-surgical recovery
- Spinal stenosis
- Sciatica
- Spondylolisthesis
None of these conditions or diagnoses will always rely on an epidural for the best outcome. In fact, you may be diagnosed with a herniated disc or sciatica, and never hear about epidurals as a potential treatment path. This is because they are not always necessary. The first-line treatment for many of these conditions is a combination of non-opioid pain management techniques and professional physical therapy.
However, when an epidural does become relevant, it can be an incredibly potent tool for short-term pain relief, as well as long-term pain management. While your doctor might not bring an epidural up as a treatment option right away, they’re still a very common pain management tool. And in cases of labor and childbirth, up to 50 percent of people opt for an epidural as their analgesia of choice. It’s all about how the epidural is applied, to what end, and the condition in question.
How Are Epidurals Applied?
Epidurals can be applied via injection, a catheter, or a device called a pain pump. Single-injection epidurals are exactly as previously described. A doctor will lead a syringe into the injection site, after optionally applying a local anesthetic, and will inject the medication into the epidural space surrounding the spinal cord.
Catheter or pain pump epidurals are more long-lasting. Epidurals with a catheter are usually used for providing long-term pain relief to a patient in the hospital, such as after surgery, or for a debilitating spinal condition. In these cases, a small tube is led into the targeted portion of the epidural space through an opening made in the back. The doctor can control when medication is sent through the tube.
With a patient-controlled device or pain pump, the medication is delivered only when the patient asks for it. These pumps are programmed so that no medication will be delivered if it isn’t safe for the patient to receive another dose. The idea is that they won’t have to be forced to be medicated if the pain is subsiding while retaining the option to ask for instant pain relief when it gets worse.
How Long Do Epidurals Last?
Doctors control dosages based on patient size, age, and history. Depending on the medication, injection type, and dosage, the pain relief can kick in in a few minutes, and last a few hours. More long-term nerve blocks may even last multiple weeks. Epidural steroid injections used to treat herniated discs and swelling may take a day or two to kick in fully.
Certain circumstances can affect the effectiveness of the procedure, from sensitivity to certain medications, to other related conditions, such as low blood pressure.
Short-Term vs. Long-Term Pain Management
Ultimately, an epidural can be a short-term or long-term pain management tool depending on when and how it is applied, and to what end.
If your doctor brings up the idea of using epidurals for back pain, don’t be frightened or discouraged. It is a well-tolerated and safe method of achieving pain relief, either long enough for the issue to resolve itself (such as a herniated disc) or to buy time for another treatment (such as spinal stenosis). Have more questions? Contact us today!
