What to Do When Epidural Injections Don’t Work

What to Do When Epidural Injections Don’t Work - PMIRSuppose you’ve ever heard of epidural injections before. In that case, it might have been in the context of childbirth – epidurals, or epidural injections, are a form of temporary painkiller or anesthetic applied via injection in the epidural layer of the spine. The injection itself is colloquially known as an epidural, but the name refers to the targeted body part rather than the medication or the injection technique. 

The epidural layer, or the epidural space, is the space between our spine and the dura mater, one of our spinal meninges or membranes. These are particular layers of connective tissue that only surround the brain and spinal cord, otherwise known as the central nervous system. Think of these membranes as a unique protective sheath around the spine and brain. The epidural layer is the thin space between this sheath and the nerves (blood vessels, sinuses, and plexuses) that make up our body’s nervous system highway. 

Targeting the epidural space is difficult. This is why, depending on where a patient is being injected, doctors rely on different measures, including imaging technology (such as computer-assisted imaging or x-ray machines) and unique, non-toxic dyes to navigate a needle into the epidural space to provide pain relief. The epidural space is most brutal to target around the neck, which is just 1 to 2 millimeters thick. It is most prominent around the lower back to the base of the spine, where it can reach up to 6 millimeters in adults. 

What Are Epidural Injections?

Epidural injections usually come in one of two different flavors – anesthetic injections and steroid injections. Anesthetic injections are somewhat self-explanatory. These injections use specific drugs that block the receptors of the nerve cells that make up the nerves in the targeted space to block most neural signals, particularly pain signals.

Since our nerves rely on chemical communication to transmit signals from the body to the brain and back, particular anesthetic medication acts as a “blocker,” filling out receptors and keeping these neurochemicals from being read and relayed. In the latter case, a doctor injects a corticosteroid into the space between your spinal nerve roots and the surrounding connective tissue. Corticosteroids are not to be confused with other kinds of steroids.

These drugs mimic the body’s cortisol production, a stress hormone in the adrenal gland. Injecting a corticosteroid in a body part struggling with intense inflammation can force the inflammation to subside. In the case of lower back pain or neck pain, especially pain associated with radiculopathy (pinched nerves), a corticosteroid can help lower inflammation and reduce pressure on the nerve roots. Unlike anesthetic injections, however, epidural steroid injections are a temporary solution. In most cases, the pain will inevitably return if the root cause has not been addressed.

In some cases, however, patients might find permanent relief after a corticosteroid injection. This is because many cases of spinal radiculopathy generally go away on their own – a corticosteroid injection can speed up the process by relieving temporary inflammation and helping a patient manage a flare-up of pain. But in chronic cases, these flare-ups can be recurring, and they can become progressively worse. Addressing the risk factors that make episodes more frequent – or more painful – is an integral part of the more extensive pain management process.

What If the Pain Doesn’t Go Away?

If your injection was successful at temporarily staving off back pain, leg pain, or arm pain, but the pain continued shortly after that – anywhere from a few hours later to a few days later – it is essential to contact and tell your doctor. Depending on how soon and how strongly the pain bounced back, they may be able to address your needs further. Regarding temporary solutions, epidural injections are a relatively low-risk and non-invasive intervention.

Your doctor may recommend a series of injections over multiple weeks to manage the worst of your symptoms while your treatment is ongoing. Your doctor may recommend epidural injections as part of a larger treatment plan, meaning that while the injection will reduce the worst symptoms, your other treatments are meant as a more long-term solution – such as corrective bracing, physiotherapy, massage therapy, vocational training, and so on.

Addressing Other Sources of Back Pain

Steroid injections are helpful in cases where inflammation is suspected to be the root cause of spinal pain. These are cases of neuropathy, where an impinged or damaged nerve is causing your pain. However, an initial diagnosis might not always be the correct diagnosis. Chronic radiculopathy, or pinched nerves, can also be caused by abnormal bone growth, scarring from an old injury, abnormal nerve healing, or even a benign tumor.

These causes aren’t always adequately addressed with corticosteroid injections. Your first epidural injection may be part of a longer diagnostic process, eliminating potential causes and narrowing down the origin of your back pain. Sometimes, a swollen or herniated disc can mask other, more severe causes of back pain. A step-by-step treatment process will help your doctor determine what’s causing your symptoms and formulate the right treatment plan.

Pain as a Complex Symptom

Pain is not a specific impulse, as much as it might seem. Many factors amplify or negate pain, and it cannot be easy to pinpoint its cause. Sometimes, it’s almost impossible to figure out a somatic or physical cause. Sometimes, it becomes worse for no reason. Pain management is an integral part of the treatment process for any spinal condition because a patient’s symptoms need to be addressed in more ways than one.

To this end, your doctor might refer you to a therapist or psychiatrist, a physiotherapist, an imaging specialist, and several other experts to help you find effective treatment modalities for your particular case. Despite similar symptoms, no two cases are exactly alike. Don’t hesitate to call us if you have questions about lower back pain, neck pain, and effective treatment modalities for pain – from nerve blocks to epidural steroid injections and more intensive interventions.

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About Pain Management & Injury Relief

Pain Management & Injury Relief is a leading patient-centered pain management clinic in Southern California. Our goal is to help you achieve long-lasting pain relief. By utilizing the latest medical technologies and equipment paired with innovative procedures and treatments, our team can help you improve your quality of life.

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