Epidural steroid injections, or ESI, are indicated for many forms of low back pain and leg pain. The goal of this treatment is pain control. Epidural injection tends to provide temporary relief from pain, and the effects could last from one week up to one year. It is especially beneficial for a patient suffering from acute back and/or leg pain. It often provides sufficient pain relief to allow for rehabilitative stretching exercises.
Epidural injections in the low back area used to treat low back pain and radicular pain (also referred to as leg pain or sciatica) but could be used for cervical (neck) pain as well. Patients who have “radicular” symptoms (such as sciatica) respond better to the injections than those who have only back pain.
How Long Does An ESI Last
It is difficult to say how long their effect will last. Generally, the immediate pain relief is from the local anesthetic injected, but this wears off in a few hours. The steroid starts kicking in between 2 to 7 days and its effect, as mentioned above, can last for several days up to a year. One can have up to three repeat injections, each two weeks apart. This should lead to a gradual but incremental improvement in pain. If there is a need to have more injections, it is advised to wait at least 6 months to a year before more injections can be administered.
Risks Involved with ESI
This procedure has very few risks, except temporary localized pain from the injection. Rarely, there may be a puncture of the “sack” containing spinal fluid, or other rare complications such as infection, bleeding, nerve damage, etc. Side effects of the injected steroid are generally temporary and include hot flushing, temporary weight gain, a short-term increase in blood sugar, etc.
How Does An ESI Work?
An epidural steroid injection delivers steroids directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ inflammatory mediators from around the area that may be a source of pain. The drugs used include a steroid as an anti-inflammatory agent. As inflammation is associated with these low back conditions, reducing inflammation tends to help with the pain. Typically used steroids include Triamcinolone acetonide, Dexamethasone, and Methylprednisolone acetate. For local anesthesia, Lidocaine (Xylocaine) is preferred as a fast-acting local anesthetic for temporary pain relief. Bupivacaine may be used a longer lasting alternative. Saline is used to diluting the local anesthetic.
It is important to note that when the injection is properly administered with fluoroscopic guidance and then confirmed through contrast-enhanced imaging, greater than 50% of patients receive some pain relief with these injections. Even if not fully effective, pain relief achieved by injections can improve a patient’s mental health and quality of life, and more importantly, minimize the need for opioid analgesic use, which has addiction potential. It can also potentially delay or in some cases, avoid surgery.
All content has been reviewed and approved by orthopedic specialist Dr. Zvezdomir “Zed” Zamfirov. Dr. Zed’s practice — All Star Pain Management and Regenerative Medicine — proudly serves the Annapolis, Greater Baltimore and Washington D.C. areas. For more, contact Dr. Zed or call 443-808-1808.