Epidural Steroid Injection has been found to be an effective adjunct to treatment for patients with neck, lower back, arm, and leg pain. Commonly, nerves in the neck or back are compressed near the spine by a bulging disc, a bone spur, or scar tissue. This causes the nerve to become irritated and swollen, causing pain, numbness or tingling radiating into the arms or legs. The purpose of the epidural injection is to decrease inflammation and provide pain relief, thereby facilitating active therapy. Their primary use is as one component of a comprehensive treatment plan that includes medication, physical therapy, and education in body mechanics.
The success of the epidural steroid injection in relieving pain is due to the potency of the anti-inflammatory medication introduced into the epidural space. Cortisone is a powerful anti-inflammatory medication which reduces nerve irritation, thus reducing pain. As you may have heard, cortisone is sometimes associated with side effects such as puffy face, brittle bones, etc. These side effects typically occur in patients who are taking cortisone by mouth for long periods of time. With epidural injection, the cortisone acts locally on the nerves and herniated disc and systemic reactions are very rare.
The medication starts to work immediately, but can take up to 2 weeks before it is entirely effective. Some patients feel relief upon injection, others after a few days to a week. You will be given an appointment for a follow up visit with your doctor to evaluate the success of the epidural injection approximately 4-7 days following epidural. If pain relief is not complete, the injection can be repeated after two weeks.
Possible side effects associated with the procedure include: numbness, dizziness, weakness for ½ hour to 4 hours after the injection; reaction to medication include minor or temporary allergic reaction which may include a temporary decrease in blood pressure (about 1 percent of the time); increased pain for one to seven days after injection; headache with or without spinal tap
As most people come to learn, our joints and tendons can start to hurt us over time. This can be due to normal degenerative processes, such as those that cause knee or hip arthritis, or due to acute injuries, such as a pulled hamstring. In either case, there may be degenerative changes in the painful area, such as thinning cartilage in the knee, rotator cuff wear and tear in the shoulder, or joint space narrowing in the hip. Also commonly present is a process that cannot be seen on x-ray or MRI, but is just as important: the process of inflammation.
Inflammation is a chemical process at the microscopic level, in which the body’s tissue reacts to overuse or injury. Inflammation can be painful. If you’ve ever had an ache or pain that was improved after taking an oral anti-inflammatory medicine, such as Alleve, Naprosyn, or aspirin, you’ve actually felt how inflammation can be painful, and how blocking inflammation can reduce pain. Taking an anti-inflammatory via the oral route (i.e. swallowing a pill) can be helpful, but has its limitations. One limitation is side-effects: taking oral anti-inflammatories can affect the lining of the stomach and esophagus, and can lead to side effects such as stomach upset, gastritis, or even ulcer. Another limitation of oral anti-inflammatory treatment comes from the fact that the stomach and intestines, were oral anti-inflammatory agents are absorbed, are organs that are designed to distribute what one eats everywhere in the body. So an anti-inflammatory pill taken orally is distributed throughout the body, and is therefore very diluted. A diluted medication can be much less effective.
A solution to the above problem of side-effects and dilution of oral anti-inflammatory medications is to place such medications directly on, or very close to, the area that is inflamed and painful. This allows the medications to pretty much stay on the area of the body we are trying to treat. This localized medication is much more concentrated, providing a stronger pain relieving effect. Localized medication also doesn’t spread throughout the body as much as if it were taken orally, reducing side-effects. Such localized anti-inflammatory treatment can be delivered by way of steroid injection.
In joint and tendon injections of steroid, we achieve a strong, localized treatment of pain due to inflammation. To assist in localizing application of the medication, we often use ultrasound guidance while providing this treatment, so that the doctor can see where the medicine is going as he or she injects it. This treatment has often provided great relief in joint and tendon pain.
Examples of such injections include:
There are many other areas where steroid injections can help. If you are experiencing longstanding, or new onset, pain anywhere in teh arms or legs, it is recommended that you seek the advice of a doctor, preferably one specializing in musculoskeletal medicine (such as a physiatrist), to help diagnose your problem. Once you've done this, it is quite possible that, among other treatments that will be provided, a joint or tendon injection may be helpful.