Epidural injections are a common source of pain relief.
The purpose of an epidural injection – also referred to as an epidural steroid injection (ESI) – is to temporarily relieve pain by delivering medication to an area between the vertebral canal and spinal cord known as the epidural space. Depending on the nature of the condition being treated, relief from epidural injections may last anywhere from several weeks or months to several years.
The purpose of this approach to pain management is to minimize pain enough so you can actively participate in physical therapy without distracting discomfort.
What Is an Epidural Injection?
An epidural injection typically contains an anesthetic numbing agent and a special type of steroid medication referred to as a corticosteroid. ESIs aren’t meant to be a permanent solution for pain relief. However, some patients experience enough relief to safely delay or even avoid surgery. Epidural injections are typically used to manage pain stemming from spine-related issues, some of which may include:
- Age-related disc wear (degenerative disc disease)
- Spinal stenosis
- Sciatic nerve irritation (sciatica)
- Vertebral slippage (spondylolisthesis)
- Spinal disc damage (disc herniation)
How Is an Epidural Injection Given?
Prior to treatment, image and nerve tests may be performed to ensure that the correct area is being targeted. Patients on blood thinning medications are usually asked to stop taking them temporarily prior to receiving an epidural injection. Prior to administering the shot, a local anesthetic is used to numb the area where the injection will be given to ease patient discomfort. Some patients may also be given a low dose oral sedative.
A special type of live X-ray called a fluoroscopy is used to ensure that the needle is correctly placed between bony vertebrae into the epidural space. The needle can be placed in several locations along the spine. A cervical ESI, for instance, is administered in the side of the neck just above the spot where there’s a nerve root opening.
A lumbar (lower back) ESI is placed around the mid-line of the back to allow access to the nerve canal. If the lowest spinal nerves need to be reached, the shot may be placed just above the tailbone (coccyx). Contrast dye is often used to confirm that the delivered medication is reaching the correct spot.
The duration of treatment will depend on how many epidural injections are being given. Most patients are able to resume their normal activities the day after treatment is completed. If there is any discomfort around the injection site, applying ice or using a mild analgesic may relieve it.
Who Is a Preferred Candidate for This Type of Treatment?
Generally, epidural injections are only considered as a pain management solution if initial attempts at managing symptoms, such as medication and various types of physical therapy, aren’t effective. ESIs may also be recommended for patients with inflammation-based conditions that make it difficult to perform rehabilitative exercises. Epidural injections aren’t suggested for individuals with bleeding problems or infections. Pregnant women may also not be good candidates for ESIs because of possible risks associated with fluoroscopy X-rays.
A 2012 study found compelling evidence suggesting epidural injections with local anesthetics or steroid medications may effectively relieve pain from nerve compression caused by disc herniation or spinal stenosis. A 2018 study found that ESIs were a viable option for certain types of chronic neck pain and for patients not responding well to oral pain medications for certain conditions or sources of spine pain.