Back pain affects nearly everyone at some point in their adult life. Often times the exact cause of pain is not readily apparent, as there are many factors which may contribute to a patient’s back pain, including disc disease, referred pain, as well as psychological factors. This can make the exact site and level responsible for the back pain more challenging to localize and diagnose. Unfortunately, while imaging studies (X-RAYs, MRI and CT scans) are helpful in screening the spine for potential causes of back pain, sometimes they don’t demonstrate an exact cause for a patient’s pain.
Back pain may arise from any anatomic structure within or around the spine which has nerve endings and is capable of transmitting pain. These structures include discs, facet joints, muscle, nerves, ligaments and dura (the membrane lining of spinal canal). All of these structures are either directly touching or in close proximity to the epidural space. Pain may be either within the spine itself (‘axial’), or radiating from the spine (‘radicular’). Both of these types of pain are ideally alleviated with the ESI.
The Epidural Injection (ESI) is a procedure that anesthetizes the space around the spinal sac (dural sac). This procedure may be performed at any level of the spine, although is most commonly performed in the lumbar spine or cervical spine. As opposed to a selective nerve root block, or a facet injection, which target a specific nerve or joint on one side of the spine, the ESI treats several consecutive levels on both sides of the spine.
What is the epidural space?
What is an epidural and why is it helpful?
What will happen to me during the procedure?
What will happen after the procedure?
General Pre/Post Instructions
You should eat a light meal within a few hours before your procedure. If you are an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications). If you are on Coumadin, Heparin, Plavix or any other blood thinners (including Aspirin), or the diabetic medication Glucophage you must notify this office so the timing of these medications can be explained. You may need to bring a driver with you. You may return to your normal activities the day after the procedure, including returning to work. Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys.
The discomfort generated during the epidural procedure may take several days to subside, and your physician may prescribe pain medication. During the healing process it is important to treat your back with care. Your physician will provide you with activity and physical rehabilitation guidelines. You will be required to do a special physical therapy and rehabilitation program for several weeks after your procedure. A special back support may be necessary as well as electrical stimulation to lessen spasms. You should be able to resume regular activity four hours after your procedure. You may have to undergo a nerve conduction study and EMG to help determine the severity and duration of back injury.
You may experience an increase in your usual pain including muscle soreness in your back where the needles were inserted. Use ice packs three or four times a day and take your usual pain medications. Do not apply heat or soak in water (i.e. tub, pool, jacuzzi, etc.) for the remainder of the day.
Duration of Relief
Most patients will have 2-3 months of relief of some of their complaints. This can range from no relief to near absolute relief with the duration being from days to many months. Some patients may not get any relief with the first injection but after one or two more done over the following weeks. Many physicians will do these injections in cycles (series) where they will do one, two or three epidural injections over a couple of weeks. The interval between these cycles should be somewhere between two to three months. More frequent administration of steroids could lead to more serious side effects.
Transforaminal epidural steroid injection series will often last for 4-6 months or even longer.