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EPIDURAL STEROID INJECTIONS
     

Q: WHAT IS AN EPIDURAL STEROID INJECTION?

A: An epidural steroid injection is an injection of a long lasting medication similar to cortisone into the epidural space.  The epidural space is the area which surrounds the spinal cord and the nerves coming out of it.

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Q: WHAT IS THE PURPOSE OF THE INJECTION?

A: The steroid injection reduces inflammation around the nerves in the epidural space.  This will usually reduce pain, tingling, numbness and other symptoms.

Q: HOW LONG DOES THE INJECTION TAKE?

A: The injection itself only takes a few minutes.  It actually takes more time to get you positioned comfortably, wash your back off with a sterile soap and set up our supplies for the procedure.

Q: WHAT IS ACTUALLY INJECTED?

A: The injection contains the steroid medication and usually a small amount of local anesthetic similar to novocaine.

Q: WHY DO YOU USE FLUOROSCOPY (X-RAYS) DURING THE PROCEDURE?

A: We use fluoroscopy so that we can advance the needle to a precise location.  Then we inject X-ray dye and see that the dye spreads within the epidural space to prove that the needle is correctly placed.  This takes more time than doing the injection without fluoroscopy, but helps us to give you the best possible results.

Q: WILL IT HURT?

A: You might feel a sting when the skin is first numbed up and then deep pressure as the needle is advanced through the muscles of the back to reach the target.  Most patients feel only slight pain during the procedure.  Our goal is for you to be as comfortable as possible during the procedure, so we have intravenous medication available if you wish.  About half of our patients choose to receive intravenous medication for the injection.  Most of the patients who do the injection with just local anesthesia to numb the skin tell us this worked fine and choose to have repeat injections done in the same way.

Q: WILL I BE ASLEEP FOR THIS PROCEDURE?

A: It is not safe for you to be completely unaware during the injection, but we can provide you with enough intravenous medication to be quite relaxed and comfortable.

Q: WHAT SHOULD I EXPECT AFTER THE INJECTION?

A: You might feel some numbness and slight weakness after the injection, due to the local anesthetic that was injected with the steroid.  Most people have only mild soreness at the injection site.  This is usually well controlled with ice and pain medications such as acetaminophen (Tylenol) or ibuprofen.  Every now and then patients are quite sore after the injection and choose to take stronger pain medications for a few hours or a few days.  Most patients notice an improvement in their pain within the first few days, but sometimes the pain relief doesn’t start until about one week after the injection.

Q: WHAT SHOULD I DO AFTER THE PROCEDURE?

A: We advise patients to take it easy for the rest of the day.  Some people choose to return to work immediately afterwards, and almost everyone is able to return to work the day after the procedure.  If you receive intravenous sedation you will need to have a ride home and will not be able to drive or return to work until the following day.

Q: HOW LONG DOES THE EFFECT OF THE MEDICATION LAST?

A: This can be difficult to predict since everybody responds differently to the injection.  It can last anywhere from a few days to as many as three or four months.

Q: HOW MANY INJECTIONS DO I NEED TO HAVE?

A: Usually one to three epidural injections are done, depending on how well you do after each one. Some patients get great relief after just one injection and do not need anymore.  Some get good partial pain relief from the first injection and will do best if we repeat the injection in two to three weeks.  Others get only slight pain relief or no relief at all, and for them we need to consider whether to do the injection again at a slightly different location in the epidural space, or even do a completely different type of injection. 

Q: WILL THE EPIDURAL STEROID INJECTION HELP ME?

A: Most patients will notice quite a bit of improvement.  If you also do the things you can do to help yourself, such as a well rounded exercise program, stretching and weight reduction, you will most likely see even more relief.

Q: WHAT ARE THE RISKS?

A: There are minor common risks from either putting in the needle or the cortisone.  You might be sore afterwards.  The cortisone might cause facial flushing, a headache, fatigue or irritability for a day or two.  Diabetics will notice an increase in their blood sugar for up to a few weeks and may need to temporarily adjust their medications.  There is also a rare chance of infection, nerve injury or making your pain worse.  Serious side effects are extremely rare. There is also a chance that the injection may not help you.

Q: WHO SHOULD NOT HAVE THIS INJECTION?

A: You should not have the procedure if you have an infection.  It is safer to wait until after the infection is treated.  If you are on coumadin, plavix or ticlid we will need to stop those medications in advance of the procedure.

Q: WHAT CAN I DO TO IMPROVE MY CHANCES FOR SUCCESS?

A: You can do a lot to help yourself.  Work up to being as physically fit as you can be.  Start slowly and build up to a good level of fitness that includes aerobic exercise, strengthening and stretching.  Weight control is also very important to reduce pressure on discs and nerves.  Please let us know what we can do to help you succeed.

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