Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
Epidural steroid injections deliver medication directly (or very near) the source of pain generation. In contrast, oral steroids and painkillers have a dispersed, less-focused impact and may have unacceptable side effects. Additionally, since the vast majority of pain stems from chemical inflammation, an epidural steroid injection can help control local inflammation while also “flushing out” inflammatory proteins and chemicals from the local area that may contribute to and exacerbate pain.
Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine or bupivacaine), and/or saline is used.
A steroid, or cortisone, is usually injected as an anti-inflammatory agent. Inflammation is a common component of many low back conditions and reducing inflammation helps reduce pain. Triamcinolone acetonide, Dexamethasone, and Methylprednisolone acetate are commonly used steroids.
Lidocaine (also referred to as Xylocaine) is a fast-acting local anesthetic used for temporary pain relief. Bupivacaine, a longer lasting medication, may also be used. Although primarily used for pain relief, these local anesthetics also act as ‘flushing’ agents to dilute the chemical or immunologic agents that promote inflammation.
Saline is used to dilute the local anesthetic or as a ‘flushing’ agent to dilute the chemical or immunologic agents that promote inflammation.
While the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year) an epidural steroid injection can deliver substantial benefits for many patients experiencing low back pain.
When proper placement is made using fluoroscopic guidance and radiographic confirmation through the use of contrast, > 50% of patients receive some pain relief as a result of lumbar epidural steroid injections.
Pain relief is more often felt for primary radicular (leg) pain and, less prominently, low back pain.
The pain relief and control brought on by injections can improve a patient’s mental health and quality of life, minimize the need for painkiller use, and potentially delay or avoid surgery.
Recent research reports that lumbar epidural steroid injections are successful in patients with persistent sciatica from lumbar disc herniation, with more than 80% of the injected group with disc herniation experiencing relief (in contrast to 48% of the group that received a saline placebo injection).
Similarly, in a study focused on a group of patients with lumbar spinal stenosis and related sciatica symptoms, 75% of patients receiving injections had more than 50% of pain reduction one year following the injections. The majority also increased their walking duration and tolerance for standing.
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