In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common. Epidural steroid injections can help resolve pain permanently in patients with a new disc herniation who respond favorably. For patients with chronic pain or recurrent disc herniations, the desired duration of effect is three to six months or more.
The risks in any procedure involving a needle include bleeding, infection and nerve damage. When performed properly, the risk of any of these is exceedingly low and usually outweighed by the potential benefit of the procedure. Some contraindications for performing epidural steroid injections include:.
Common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, or increased blood sugar. These are usually self-limited and resolve within one to three days. A less common side effect is headache. Your doctor will give you specific instructions and these will vary by facility and type of epidural lumbar, thoracic or cervical.
Because the procedure is usually performed with local anesthetic, fasting guidelines are not overly prohibitive. A local anesthetic is injected into the skin, numbing the area where the epidural needle is then placed. Patients may experience mild discomfort but should not experience severe pain during the procedure. The procedure can last anywhere from 10 to 20 minutes and requires the patient to lie prone, if possible, to allow for X-ray guidance fluoroscopy. After the procedure, you can sit, stand, and walk as usual after a short period of monitoring.
Epidural steroid injections at HSS are performed by several types of doctors — pain management physicians , physiatrists and interventional radiologists — all of whom are trained to safely perform this procedure, often with additional subspecialty fellowship training. An epidural steroid injection will not correct the preexisting medical problem such as spinal stenosis, herniated or bulging disc, arthritis, etc. It is not unusual for someone to need more than one injection to get long-term benefit.
The injections are done in a series of three injections about a month apart if needed. If the pain is significantly improved, no further injection is needed unless the pain begins to come back. Your first visit is an initial evaluation. This appointment consists of reviewing your medical history, medications, x-rays, treatments already tried, and any other pertinent information and records.
A physical exam will be performed. A plan of care will be formulated. If an epidural steroid injection is found to be appropriate it will be scheduled as soon as possible. Injections can only be done on the first visit if precertification arrangements have been made with your insurer to allow both an initial visit and a procedure on the same day. The main risk, occurring in about one in patients, is the risk of a dural puncture. This rate is higher in patients who have had previous back surgery.
A dural puncture occurs when the needle is unintentionally advanced one layer beyond the epidural space and punctures the membrane that surrounds spinal fluid. If this occurs, there is a risk of developing a spinal headache, which may be severe and may last for days. There is a procedure epidural blood patch that can treat the headache if it occurs and does not improve sufficiently in 48 hours.
Other risks are rare and include bleeding, infection, nerve injury and allergic reaction to the medication. Some short-term side effects may occur. If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for one to two hours. If this happens you will have to stay in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection. People with diabetes may have short-term elevation of blood sugars.
People prone to fluid retention may have increased fluid retention for one to two weeks. The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. For your safety, please make your doctor aware of any of these conditions.
After you sign a consent form and your blood pressure is checked, the procedure will be performed while you are in a sitting position. For procedures in the neck, an intravenous is started. The back or neck is then cleansed with an antiseptic soap.
A sterile drape is placed. The skin is anesthetized numbed with a local anesthetic. This is felt as a stinging or burning sensation. The needle is then advanced into the epidural space. Pressure is the usual sensation.
For procedures in the neck, an intravenous is started. The back or neck is then cleansed with an antiseptic soap. A sterile drape is placed. The skin is anesthetized numbed with a local anesthetic. This is felt as a stinging or burning sensation.
The needle is then advanced into the epidural space. Pressure is the usual sensation. If you feel pain more local anesthetic will be used. Once the needle is in the epidural space, the medication is infused and the procedure is complete. Your skin will be cleansed and a bandage will be applied. The bandage can be removed on the next morning. Your blood pressure will be checked, and you will be able to leave with your ride after the doctor authorizes your discharge.
Most people do not feel any different immediately after the injection, although the pain may be temporarily improved or worsened. The steroid takes two to three days to start to have an effect in most people, and it peaks in about two weeks. Therefore, it may be a while before you feel a change in your pain. Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three to four times a day will help this.
You may take your usual pain medications as well after the injection. You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you. No heat is to be used in the injected areas for the remainder of the day.
You should not take a tub bath, hot shower, or soak in water such as a pool or hot tub for the remainder of the day. You may eat, drink and take your medications as usual on the day of the procedure both before and after unless told otherwise by your doctor. If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call the Center for Pain Medicine at For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.
Stay Informed. Connect with us. Epidural Steroid Injections. What can I expect on my first visit? What are the risks of the procedure? Will the injection hurt? This may occur after the numbing medicine wears off but before the steroid has had a chance to work. Ice packs may help reduce the inflammation and will typically be more helpful than heat during this time.
Improvements in pain will generally occur within 10 days after the epidural injection, and may be noticed as soon as one to five days after the injection. Regular medicines may be taken after an epidural steroid injection. On the day following the procedure, the patient may return to his or her regular activities.
When the pain has improved, regular exercise may be resumed in moderation. Even if improvement is significant, activities should be increased slowly over one to two weeks to avoid recurrence of pain. Types of Spinal Injections Video. Radiculopathy, Radiculitis and Radicular Pain. Injections for Neck and Back Pain Relief. Epidural Steroid Injections. Cervical Epidural Steroid Injection Video.
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