Epidural Steroid Injections for Back and Neck pain

Mark Schlimgen, MD
Pain Management
Pain Clinic of Northwestern Wisconsin
Eau Claire

What is an Epidural Steroid Injection?
An Epidural Steroid Injection is an injection of long lasting steroid (“cortisone”) in the epidural space – that is the area which surrounds the spinal cord and the nerves coming out of it. Nerves travel through the epidural space to the back or neck and into the legs or arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.

What is the purpose of it?
The steroid injected reduces the inflammation and/or swelling of nerves in the epidural space. The purpose is to reduce pain while waiting for injuries to heal. This may in turn reduce pain, tingling and numbness and other symptoms caused by nerve inflammation. Irritation of a spinal nerve in the low back causes pain that goes down the leg. Irritation of a spinal nerve in the neck causes pain that goes down the arm.

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs.

How long does the injection take and how is the injection performed?
The actual injection takes only a few minutes. To administer the epidural steroid injection, your doctor will have you lie flat, or face down. The skin on the back or the neck is scrubbed using sterile soap. Next, the physician numbs a small area of skin with local anesthetic. This medicine stings for several seconds. The physician uses a special x-ray machine called fluoroscopy to aid in the placement of the epidural needle. Using special landmarks, a needle will be advanced to an area very near to the spinal nerves, called the epidural space.

Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. Most of the patients admit that the procedure was not as painful as they thought it would be. An awake patient makes the best monitor for safety.

What should I expect after the injection?
Immediately after the injection, your legs or arms may feel heavy. You may notice that your pain is decreased or gone. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a “sore back” for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the third or fourth day, although occasionally it may take longer.

What should I do after the procedure?
You should have a ride home. We advise patients to take it easy for a day or so after the procedure. Perform activities as tolerated by you.

Can I go back to work the next day?
You should be able to unless the procedure was complicated. Usually you will feel some back pain or have a “sore back” only.

How long will the effect of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 4 days and its effect can last a few weeks to months.

How many injections do I need to have?
If the first injection does not relieve your symptoms in one to two weeks, you may be recommended to have one more injection. If most of your symptoms are gone, there is no good reason to do additional injections. If activity level is acceptable and strong pain relievers are no longer required, then it is best to wait on further injection therapy.

Can I have more than three injections?
No more than three doses of cortisone in a 4–6 week period of time. Once you have had maximum exposure then you will need a six-month break from further steroid exposure.

Will the Epidural Steroid Injection help me?
Generally patients who have “radicular symptoms” (like sciatica) respond better to epidural injections than the patients who have only back pain. Similarly, patients with a recent onset of pain may respond much better than the ones with a long standing pain.

What are the risks and side effects?
This procedure is safe. However, as with any procedure there are risks. The most common side effect is pain – which is temporary. The other risks include spinal headache, infection, bleeding inside the epidural space with nerve damage and worsening of symptoms, etc. Other risks are related to the side effects of cortisone. These include weight gain, increase in blood sugar (mainly in diabetics), water retention, decrease in bone density, suppression of the body’s own natural production of cortisone, flushing, insomnia, cataracts and other more uncommon side effects.

Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection going on, you should talk to your Pain Physician before having an injection.

Dr. Schlimgen – Pain Clinic of Northwestern Wisconsin
For information or to schedule an appointment:
715.552.5346 | 888.235.7246 | painclinic-nw.com
Dr. Schlimgen sees patients in Eau Claire, Rice Lake, Cumberland,
Menomonie and Lake Elmo, MN.