Epidural Injections

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RADICULAR PAIN (LEG OR ARM PAIN) – EPIDURAL STEROID INJECTIONS
What is radicular pain?
Radicular pain originates as a result of irritation of a nerve root due to a herniated disc or
degenerative arthritis of the spine that causes pinching of the nerve root. Patients
typically experience a shooting pain into the leg or arm, usually on one side of the body.
Numbness, tingling, and/or weakness may accompany the pain. The most commonly
affected levels in the lower back are L4-5 and L5-S1 and C5-6 and C6-7 in the neck,
although any level can be involved.
How is radicular pain diagnosed? Do I need an MRI?
Radicular pain is diagnosed by history and physical examination, but an MRI is
oftentimes required to correlate the findings and plan injections or even surgery. MRIs
are not magical pictures of pain. There are many people who have terrible-looking MRIs,
but have no pain. On the contrary, there are many people who have perfect-appearing
MRIs with lots of pain. Your doctor will use all the information at his or her disposal to
assess where your pain is most likely coming from and plan a targeted treatment to that
area.
What is the treatment of radicular pain?
Treatment of radicular pain is initially conservative, with physical therapy, a short course
of opioid pain medicine (e.g. Percocet), NSAIDs (e.g. ibuprofen, naproxen), and nerve
pain medications (e.g. gabapentin). Epidural steroid injections have been shown to
provide short-term pain relief in patients with acute radicular pain.
What is an epidural steroid injection?
An epidural steroid injection is a targeted minimally invasive procedure that can help
relieve radicular pain in the neck, arm, back, and leg. There are multiple approaches to
the epidural space, and your doctor will choose the one most appropriate for your
anatomy. The doctor will use x-ray guidance to place 1-3 needles into the area(s) that
correspond to your pain complaint. The doctor will then use a small amount of contrast
dye to ensure the medication will spread to the appropriate area. Thereafter, he or she will
inject a mixture of steroid and numbing medicine into the area.
What are the risks of epidural steroid injections?
Any time we break the skin, there is risk of bleeding or infection. These are minimal if
patients are not on any blood thinners and have no current infections. Any time we put
steroids into the body, there are effects from the steroids, including increased blood sugar
and worsening of any existing infection. In the low back, there are risks of back pain,
headache, worsening the pain, not helping the pain, and causing persistent numbness and/
or weakness. In most individuals, the spinal cord ends at L1-2, so any injections below
those levels have essentially no risk of spinal cord injury or paralysis. Cervical and
thoracic spine (neck and mid-back) injections are done in an area where the spinal cord is
present, so there is a very rare chance of injury to the spinal cord including paralysis.
Your doctor will take great care and uses X-ray guidance to ensure that this is done safely
without any injury to the spinal cord.
Do I need anesthesia for an epidural steroid injection?
You may have your epidural steroid injection with local or with sedation. Most
individuals do well with just local, in which numbing medicine is used to reduce any
discomfort from the needle. Individuals who have a fear of needles or who are extremely
sensitive to pain may benefit from sedation. Your doctor will discuss the options with you
and come to a mutual decision.
What should I expect during an epidural steroid injection?
First, your back will be cleaned with an antiseptic solution and a sterile drape will be
placed. Next, the doctor will identify the area he or she will inject using an x-ray
machine. Once the location is identified, you will feel a pinch and a burn as numbing
medicine is injected into that spot using a fine needle. After the numbing medicine takes
effect, you should only feel pressure as the doctor places an epidural needle into the
correct position using multiple x-rays. Once the needle is in the epidural space, you may
feel pressure or even worsening of your typical pain as the doctor injects the medication.
Are there any restrictions after an epidural steroid injection?
There are very few restrictions after this type of injection. The only restriction is that you
should not soak in a tub or other body of water for 24 hours.

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