Epidural injections are one nonsurgical method of treating chronic neck and low back pain. These injections involve placement of cortisone and a numbing medication into the epidural space that surrounds the nerve roots in the spine. These injections are frequently performed by anesthesiologists, physiatrists, or interventional radiologists with specialized training and are done under a fluoroscope (a live X-ray machine) to insure proper placement.
The two most common causes of low back pain are disc damage and facet disease. Pain from disc damage can result from tearing of the disc, which can cause pain itself, and leakage of noxious disc material into the epidural space which can further cause pain. A disc “bulge” or protrusion can also encroach on nerve roots in the spine and cause “radicular” pain (pain down the leg or arm). An epidural injection aims to reduce inflammation and counteract painful mediators from these causes of neck and low back pain.
Spinal Stenosis, according to WebMD, is “is the narrowing of spaces in the spine (backbone) which causes pressure on the spinal cord and nerves.” An epidural injection can reduce the narrowing in the spine if there is true inflammation in the area. Furthermore, cortisone can directly block some pain fibers and decrease sensitivity to pain mediators.
Medication is injected into the area around the damaged or inflamed nerves as part of an outpatient procedure. The following steps are taken:
- Cleaning the skin
- Injecting a numbing agent
- Inserting a needle through the skin toward the spine
- Using fluoroscopy (live x-ray video) to move the needle between spinal bones
- Using contrast dye to ensure the needle is in the epidural space
- Injecting a solution (generally a steroid coupled with an anesthetic for pain)
It is typical for patients to feel some soreness or mild pain at the site of the injection. However, any side effects that seem unusual should be taken to an experienced physician just to be sure everything is OK.
In instances of pronounced back pain, epidural injections can be a reliable form of pain management. However, the treatment may only be used a few times per year as the steroids mimic the effects of hormones. Although this mimicry helps to fight nerve inflammation and pain, it also disrupts your body’s hormone balance and may weaken spinal bones and nearby muscles. However, if the injections are spaced out and your body can return to hormone stasis, there are few risks associated with the treatment.