23 Apr Epidural for Back Pain Pros and Cons
Many people want to relieve their chronic back pain but are afraid of surgical options and how costly they are. Among the multiple interventions used to manage chronic back pain, epidural injections are another option for patients looking to avoid a major back surgery. Epidural injections have a reputation for use in pregnancy and birth, but they can also be used for back pain. The epidural used for therapeutic pain relief is completely different than the anesthetic used for childbirth. Although the injection is performed in a hospital, it is not a surgical procedure and you will be able to go home the same day. Epidural injections are a quick procedure that can provide pain relief from several weeks to several months, relieving the burden of constant pain and daily treatments.
What Is an Epidural Injection and How Does It Work?
An epidural steroid injection (ESI) is the delivery of a powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord called the epidural space. Your doctor may recommend ESI if you have pain that spreads from your lower spine down to the hips, or leg, when medicine, physical therapy, and other nonsurgical measures have failed. This pain is caused by pressure on a nerve, most often due to a bulging spinal disk. ESI is done in a hospital or outpatient clinic the following way:
- You change out of your clothes into a hospital gown.
- You lie face down on an x-ray table.
- The health care provider cleans the area and numbs it.
- A needle is inserted into your back with the help of an x-ray machine for guidance.
- A mixture of steroid and numbing medicine is injected into the area. This medicine decreases swelling and pressure on the larger nerves around your spine and helps relieve pain.
- Some pressure may be felt during the procedure, but you should be very still.
- You are watched for 15 to 20 minutes after the injection before going home.
- If you are given any medicines to calm or sedate you, arrange for someone to drive you home.
Pros of Epidural Injections
- Nonsurgical option for pain relief
- Quick procedure with little to no pain from injection
- ESI provides short-term pain relief in at least one-half of the people who receive it. Symptoms may remain better for weeks to months, but rarely up to a year
- Targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root
Cons of Epidural Injections
- Dizziness, headache, or feeling sick to your stomach. Most of the time these are mild
- Nerve root damage with increased pain down your leg
- Infection in or around your spine (meningitis or abscess)
- Allergic reaction to the medicine used
- Bleeding around the spinal column (hematoma)
- Possible rare brain and nervous system problems
- Having these injections too often may weaken the bones of your spine or nearby muscles. Receiving higher doses of the steroids in the injections may also cause these problems
- The procedure does not cure the cause of your back pain
- There are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections