© Therapeutic Pain Management Medical Clinic 2016 - Site created by Dr. Dhruva 1335 Buenaventura Blvd, Ste 100, Redding, CA 96001. T: (530) 247-7246; (530) 24-7-P-A-I-N.   F: (530) 245-0849   email: mail@TPMclinic.com
Therapeutic Pain Management Medical Clinic (TPM) Improving Quality of Life
  Epidural Steroid Injection FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   Lumbar   Epidural   Steroid   Injection.   It   is   one   of   the   common   procedures   performed   in   this pain clinic.  The following material is given as general information only, and is not to be considered as medical advice or a consultation.  What is an Epidural Steroid Injection? 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. What is the purpose of it and what are the indications? The   steroid   injected   reduces   the   inflammation   and/or   swelling   of   nerves   in   the   Epidural   space.   This   may   in   turn   reduce   pain,   tingling   &   numbness   and   other symptoms   caused   by   nerve   inflammation   /   irritation   or   swelling   -   which   may   be   due   to   a   herniated   disk,   scar   tissue   or   a   bone   spur.   In   most   cases,   the   procedure is   indicated   for   chronic   radicular   ( think   sciatica)    symptoms   with   at   least   moderate   pain   affecting   quality   of   life,   which   has   not   responded   to   conservative treatments   (such   as   physical   theraly,   anti-inflammatory   medications)   and   there   is   MRI   or   CT   scan   or   EMG   evidence   supporting   a   radicular   disease   process, matched   with   symptoms   and   findings   on   clinical   evaluation.   Epidural   steroid   injections   striclty   for   back   or   neck   pain,   in   general,   are   not   supported   by   most clinical guidelines. How long does the injection take? The actual injection takes only a few minutes. What is actually injected? The    injection    consists    of    a    mixture    of    local    anesthetic    (like    lidocaine    or    bupivacaine)    and    the    steroid    medication    (triamcinolone    –    Kanalog®    or methylprednisolone – Depo-Medrol® or Celeston-Soluspan or dexamethasone. Will the injection hurt? The   procedure   involves   inserting   a   needle   through   skin   and   deeper   tissues   (like   a   “tetanus   shot”).      So,   there   is   some   discomfort   involved.   However,   we   numb   the skin   and   deeper   tissues   with   a   local   anesthetic   using   a   very   thin   needle   prior   to   inserting   the   Epidural   needle.      Most   of   the   patients   also   receive   intravenous sedation and analgesia, which makes the procedure easy to tolerate. Will I be “put out” for this procedure? No.   This   procedure   is   generally   performed   under   local   anesthesia.   A   few   of   the   patients   also   receive   intravenous   sedation   and   analgesia,   which   makes   the procedure easy to tolerate.  The amount of sedation given generally depends upon the patient tolerance. How is the injection performed? It   is   done   either   with   the   patient   sitting   up   (for   Neck)   or   laying   on   the   stomach   (for   back).   The   patients   are   monitored   with   EKG,   blood   pressure   cuff   and   blood oxygen-monitoring device.  The skin is cleaned with antiseptic solution and then the injection is carried out.  What should I expect after the injection? Immediately   after   the   injection,   you   may   feel   your   legs   slightly   heavy   and   may   be   numb.   Also,   you   may   notice   that   your   pain   may   be   gone   or   quite   less.   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 form the steroid itself. You should start noticing pain relief starting the 3rd day or so. What should I do after the procedure? You should have a ride home.  We advise the patients to take it easy for a day or so after the procedure.  Perform the activities as tolerated by you. Can I go to work to work the next day? Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back. How long 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   5   days   and   its   effect can last for several days to a few months. How many injections do I need to have? If   the   first   injection   does   not   relieve   your   symptoms   in   about   a   week   to   two   weeks,   you   may   be   recommended   to   have   one   more   injection.   If   you   respond   to   the injections   and   still   have   residual   pain,   you   may   be   rarely   recommended   for   a   third   injection.   In   general,   at   least   50%   relief      for   4   to   6   weeks   with   improved   quality of life is needed after the first injection inorder to consider a repeat injection. Can I have more than three injections? In   a   six-month   period,   we   generally   do   not   perform   more   than   three   injections.   This   is   because   the   medication   injected   lasts   for   about   six   weeks.   If   three injections   have   not   helped   you   much,   it   is   very   unlikely   that   you   will   get   any   further   benefit   from   more   injections.   Also,   giving   more   injections   will   increase   the likelihood   of   side   effects   from   cortisone.   In   general,   you   should   get   at   least   50%   relief   of   your   radicular   pain   for   at   least   four   to   six   weeks   or   longer,   accompanied by improved activities and reduction in the use of medications for us to consider a repeat procedure. Will the Epidural Steroid Injection help me? It   is   very   difficult   to   predict   if   the   injection   will   indeed   help   you   or   not.   Generally   speaking,   the   patients   who   have   “radicular   symptoms”   (like   sciatica)   respond better   to   the   injections   than   the   patients   who   have   only   back   pain.      Similarly,   the   patients   with   a   recent   onset   of   pain   may   respond   much   better   than   the   ones with   a   long   standing   pain.   Also,   the   patients   with   back   pain   mainly   due   to   bony   abnormality   may   not   respond   adequately.   Typically,   this   procedure   offers   more pain relief than relief of numbness or weakness - which can take a long time to resolve, if any. What are the risks and side effects? Generally   speaking,   this   procedure   is   safe   when   performed   by   an   experienced   physician   with   the   use   of   fluroscopy.   However,   with   any   procedure   there   are   risks, side   effects,   and   possibility   of   complications.   The   most   common   side   effect   is   pain   –   which   is   temporary.      The   other   risk   involve   spinal   puncture   with   headaches, infection,   bleeding   inside   the   Epidural   space   with   nerve   damage,   worsening   of   symptoms   etc.      The   other   risks   are   related   to   the   side   effects   of   cortisone:   These include   weight   gain,   increase   in   blood   sugar   (mainly   in   diabetics),   water   retention,   suppression   of   body’s   own   natural   production   of   cortisone   etc.      Fortunately, the serious side effects and complications are uncommon, but higher in the cervical region due to its anatomy. 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.   Plavix,   Coumadin,   Pradaxa,   Effient,   Xarelto),   or   if   you have an active infection going on, or have uncontrolled diabetes, you should not have the injection.
© Therapeutic Pain Management Medical Clinic 2016 Web designed and  created by Dr. Dhruva
Therapeutic Pain Management Medical Clinic Improving Quality of Life
  Epidural Steroid Injection FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   Lumbar Epidural   Steroid   Injection.   It   is   one   of   the   common   procedures   performed   in   this pain   clinic.      The   following   material   is   given   as   general   information   only,   and   is   not to be considered as medical advice or a consultation.  What is an Epidural Steroid Injection? 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. What is the purpose of it? The   steroid   injected   reduces   the   inflammation   and/or   swelling   of   nerves   in   the Epidural   space.   This   may   in   turn   reduce   pain,   tingling   &   numbness   and   other symptoms   caused   by   nerve   inflammation   /   irritation   or   swelling   -   which   may   be due   to   a   herniated   disk,   scar   tissue   or   a   bone   spur.   In   most   cases,   the   procedure is   indicated   for   chronic   radicular   ( think   sciatica)    symptoms   with   at   least   moderate pain   affecting   quality   of   life,   which   has   not   responded   to   conservative   treatments (such   as   physical   theraly,   anti-inflammatory   medications)   and   there   is   MRI   or   CT scan    or    EMG    evidence    supporting    a    radicular    disease    process,    matched    with symptoms   and   findings   on   clinical   evaluation.   Epidural   steroid   injections   striclty for back or neck pain, in general, are not supported by most clinical guidelines. How long does the injection take? The actual injection takes only a few minutes. What is actually injected? The    injection    consists    of    a    mixture    of    local    anesthetic    (like    lidocaine    or bupivacaine)     and     the     steroid     medication     (triamcinolone     –     Kanalog®     or methylprednisolone – Depo-Medrol® or Celeston-Soluspan or dexamethasone. . Will the injection hurt? The   procedure   involves   inserting   a   needle   through   skin   and   deeper   tissues   (like   a “tetanus   shot”).      So,   there   is   some   discomfort   involved.   However,   we   numb   the skin   and   deeper   tissues   with   a   local   anesthetic   using   a   very   thin   needle   prior   to inserting    the    Epidural    needle.        Most    of    the    patients    also    receive    intravenous sedation and analgesia, which makes the procedure easy to tolerate. Will I be “put out” for this procedure? No.   This   procedure   is   done   under   local   anesthesia.   A   few   of   the   patients   also receive   intravenous   sedation   and   analgesia,   which   makes   the   procedure   easy   to tolerate.      The   amount   of   sedation   given   generally   depends   upon   the   patient tolerance. How is the injection performed? It   is   done   either   with   the   patient   sitting   up   (for   Neck)   or   laying   on   the   stomach   (for back).    The    patients    are    monitored    with    EKG,    blood    pressure    cuff    and    blood oxygen-monitoring   device.      The   skin   is   cleaned   with   antiseptic   solution   and   then the injection is carried out.  What should I expect after the injection? Immediately   after   the   injection,   you   may   feel   your   legs   slightly   heavy   and   may   be numb.   Also,   you   may   notice   that   your   pain   may   be   gone   or   quite   less.   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   form   the   steroid itself. You should start noticing pain relief starting the 3rd day or so. What should I do after the procedure? You   should   have   a   ride   home.      We   advise   the   patients   to   take   it   easy   for   a   day   or so after the procedure.  Perform the activities as tolerated by you. Can I go to work to work the next day? Unless   there   are   complications,   you   should   be   able   to   return   to   your   work   the next day. The most common thing you may feel is sore back. How long 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   5   days   and   its   effect   can last for several days to a few months. How many injections do I need to have? I If   the   first   injection   does   not   relieve   your   symptoms   in   about   a   week   to   two weeks,   you   may   be   recommended   to   have   one   more   injection.   If   you   respond   to the   injections   and   still   have   residual   pain,   you   may   be   rarely   recommended   for   a third   injection.   In   general,   at   least   50%   relief      for   4   to   6   weeks   with   improved quality   of   life   is   needed   after   the   first   injection   inorder   to   consider   a   repeat injection. Can I have more than three injections? In   a   six-month   period,   we   generally   do   not   perform   more   than   three   injections. This    is    because    the    medication    injected    lasts    for    about    six    weeks.    If    three injections   have   not   helped   you   much,   it   is   very   unlikely   that   you   will   get   any further   benefit   from   more   injections.   Also,   giving   more   injections   will   increase   the likelihood of side effects from cortisone. I Will the Epidural Steroid Injection help me? It   is   very   difficult   to   predict   if   the   injection   will   indeed   help   you   or   not.   Generally speaking,    the    patients    who    have    “radicular    symptoms”    (like    sciatica)    respond better   to   the   injections   than   the   patients   who   have   only   back   pain.      Similarly,   the patients   with   a   recent   onset   of   pain   may   respond   much   better   than   the   ones   with a    long    standing    pain.    Also,    the    patients    with    back    pain    mainly    due    to    bony abnormality   may   not   respond   adequately.   Typically,   this   procedure   offers   more pain   relief   than   relief   of   numbness   or   weakness   -   which   can   take   a   long   time   to resolve, if any. What are the risks and side effects? Generally   speaking,   this   procedure   is   safe   when   performed   by   an   experienced physician   with   the   use   of   fluroscopy.   However,   with   any   procedure   there   are   risks, side   effects,   and   possibility   of   complications.   The   most   common   side   effect   is pain    –    which    is    temporary.        The    other    risk    involve    spinal    puncture    with headaches,    infection,    bleeding    inside    the    Epidural    space    with    nerve    damage, worsening   of   symptoms   etc.      The   other   risks   are   related   to   the   side   effects   of cortisone:   These   include   weight   gain,   increase   in   blood   sugar   (mainly   in   diabetics), water   retention,   suppression   of   body’s   own   natural   production   of   cortisone   etc.     Fortunately,    the    serious    side    effects    and    complications    are    uncommon,    but higher in the cervical region due to its anatomy. 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.   Plavix,   Coumadin,   Pradaxa,   Effient,   Xarelto),   or   if   you have   an   active   infection   going   on,   or   have   uncontrolled   diabetes,   you   should   not have the injection.