In this article, we would be studying all about Epidural steroid injections (ESIs). This will help us get a clear and complete insight about these steroid injections.
An Epidural steroid injection is an injection of cortisone, long-lasting steroid, administered in the Epidural area. Epidural Area refers to the area that surrounds the spinal cord and the nerves coming out of the cord.
Epidural steroid injection or epidural injection is generally used to minimize the pain caused by a herniated disc, spinal stenosis, or degenerative disc ailment. These three spinal ailments are often the reasons behind pain observed in the neck (cervical) and lower back (lumbar) areas of the body spine.
It has been scientifically proven that such injections minimize the inflammation and swelling of nerves in the Epidural Area. These relief activities help in reducing tingling, pain, numbness, and other symptoms due to swelling, nerve inflammation, and irritation. An ESI injection is mostly used in combination with an exhaustive rehabilitation program to offer additional benefits to the concerned patients.
An ESI Injection includes a mixture of local anesthetics such as bupivacine or lidocaine along with steroid medications such as triamcinolone – Aristocort® or methylprednisolone – Depo-medrol®, Celestone-Soluspan. The injection is administered via insertion of the medical needle through skin and deeper tissues. Even though there is very little pain associated with administering the ESI injection, a patient can ask the doctor to use the local anesthetics, intravenous sedation, or analgesia to reduce the pain further.
ESIs, that take only a few minutes for administering, are considered to be one of the most common options for varying forms of leg and low back pain. These injections have been administered to people with low back ailments since 1952. Furthermore, the usage of ESIs has been as an integral and important part in the non-surgical management of low back pain and sciatica.
It is believed that epidural injections are low-risk and non-surgical tools to help a patient stay healthy against problems such as radicular and back pain, which are caused by inflammation.
A patient who has just been administered an ESI injection may feel numbness and slightly heavy legs. This may last for a maximum period of one hour but the patient may feel a sore back for a day or two. Complete relief from pain can be expected after third day from the day when the injection was administered.
If a patient who has been administered with an epidural steroid injection complains of a painful headache while performing routine works such as walking, sitting or standing then he may rush to seek medical intervention as there can be a probability of dural puncture. Apart from that, a fever of 101 degrees or more for a period of time more than 24 hours should not be ignored as this may be a sign of infection.
It is always advisable for patients who have an allergy to any of the medications to be injected or who all are on a blood thinning medication or who have an active infection NOT to have the ESI injection. It is essential for a patient to take a MRI Scan before being administered with an epidural steroid injection to avoid the risk of being suffering from a painful tumor or infection.
A patient suffering from swelling of nerves in the epidural area or leg, low back pain can take a maximum of three ESI injections in a year. Though not definitive or to be taken as a standard rule for all, the limit of three injections is considered to be reasonable by doctors worldwide.
Adverse Reaction of Epidural Steroid Injections
Though the ESI injections are quite safe in the general parlance, yet there always remain some adverse reactions of epidural steroid injections. Temporary pain may be felt by a patient administered with an ESI injection. There may be risks of spinal punctures, infections, bleeding inside epidural area with damage to nerves, headaches, retention of water in the body, suppression of natural produced cortisone, and a rise in the level of body sugar to name a few.
A wet tap may occur due to penetration of dural sac into the Cerebral Spinal Fluid (CSF) by the medical needle. This may cause a spinal headache or a CSF leak. One can even experience an infection into the epidural area after being administered with an ESI injection. The administration of an ESI injection may even bring a remote risk of nerve root damage.
Apart from the above-mentioned side effects, the list of side-effects may include facial flushing, increase in localized pain, non-positional headaches, sleeplessness, anxiety, restlessness, and fever on the day of injection, transient fall in the level of body immunity, high blood sugar, cataract, stomach ulcer, sever arthritis of the hips etc.
The list of adverse reaction of epidural steroid injections includes a temporary numbness of the bladder and bowels, bacterial meningitis, conus medullaris syndrome, aseptic meningitis, and arachnoiditis. However, it should be noted that most of these complications arise only after multiple subarachnoid injections over a period of time.
However, it should not be forgotten that the ESIs must be administered only after a medical advice. This can help in effective management of pain felt by a patient, which needs to be assessed and addressed on an immediate basis.
If a patient is administered with the epidural injections then the severity of pain can be minimized to a considerable extent.
When treated with ESIs on a prolonged basis, a patient can start living his life on a normal basis. The treatment can help him perform routine activities of life such as walking, sitting, and standing along with performance of other activities and work responsibilities without any pain.
The side-effects of ESIs perceived by many people are nothing but myths as these side-effects occur only when care and diligence are not observed in the right spirit or due to absence of related knowledge by a patient.
In short, the epidural steroid injections are effective non-surgical tools for patients who are suffering from acute back or radicular pain. However, the dosage should not be exceeded by three injections unless otherwise prescribed by the doctor.