• Back and Spine
• Bone and Joint Health

Epidural Injections: Relief for Your Aching Back

An irritated, inflamed or compressed – that is, pinched – nerve in the spine can cause excruciating back pain that can radiate to an arm or leg. And leave you longing for immediate relief.

When oral medications or other therapeutic methods don’t help, your doctor may recommend an epidural injection.

Epidural injections have been used for many years to deliver anti-inflammatory drugs such as steroids directly to the troubled area in the spine, to relieve the pain and inflammation.

Your spine or backbone is made up of many small bones — the vertebrae. They’re stacked atop one another with cushioning intervertebral disks between them.

Within the backbone, and protected by it, is the spinal column, a bundle of nerves that runs from the base of your brain all the way to your lower back. The material covering the spinal cord is called the dura, and the space between it and the spine is called the epidural space.

Epidural injections are delivered into the epidural space, close to the affected nerve.

The length of pain relief from an epidural injection varies from one person to another – from a few days to many months. You may need periodic injections.

How Are Epidural Injections Given?

Epidural injections are usually, though not always, an outpatient treatment. If you take blood thinners, your doctor will instruct you to stop taking them for a specific time before your scheduled injection.

Here’s how the injection is typically administered:

• You’ll be asked to lie atop a special table on your stomach or on your side.
• You’ll be given an anesthetic to numb the area of your back where the injection will be delivered.
• Using a fluoroscope (a live-motion X-ray device) or CT scan, the doctor will take care to insert the injection needle precisely into the epidural space. Contrast dye is usually injected first to help the doctor position the needle.
• The doctor will slowly inject the medicine.
• The needle will be removed, and a bandage will be placed over the injection site.

If injections make you anxious or uncomfortable, talk with your doctor before the day of your injection about whether you can be sedated. Sedation will require fasting for several hours beforehand.

After your injection, you will typically be advised to take it easy the rest of the day. If you feel pain around the injection site, you may apply an ice pack to the area for a few minutes once or twice an hour.

Don’t take other pain medication on the day of your injection without first talking with your doctor.

How Long Will the Relief Last?

The length of pain relief from an epidural injection varies from one person to another – from a few days to many months. You may need periodic injections.

It’s also possible that an epidural injection will not relieve your pain, even for a short while. In this case, your doctor will help you explore other therapeutic approaches.

But even if the relief is only temporary, it may last long enough to help you benefit from a rehabilitation program that involves stretching and exercise to promote longer-term improvement.

What Are the Risks and Possible Side Effects?

Most health procedures come with a certain amount of risk. This can vary based on your age, health and other personal circumstances. Talk with your doctor about the potential benefits and risks of epidural injection. Known risks include:

• Bleeding, infection
• A nerve injury
• A needle puncture of the dura, resulting in a leak of spinal fluid and severe headache
• No relief from your pain

Possible side effects of an epidural injection, though rare, include:

• Headaches
• Facial flushing
• Anxiety
• Sleeplessness
• Fever
• Increase in pain
• Stomach ulcers
• Arthritis of the hips
• Cataracts

Your doctor may advise against an injection if you have health conditions such as:

• Bleeding disorders
• Untreated high blood pressure
• Infection
• Heart-related chest pain
• History of heart failure 
• An allergy to contrast dye, anesthetics or steroids 

Be sure to talk with your doctor about any conditions or concerns that might put you at greater risk.

Source: Spine-health.com; Radiological Society of North America; American Academy of Orthopaedic Surgeons