Epidural Steroid Injections

Diagnostic and therapeutic epidural steroid injections for neck and back pain

Epidural steroid injections are commonly used to diagnose and treat neck and back pain. These injections are placed in the epidural space of the spine, which is located between the vertebral bones and the protective covering of the spinal cord.

What is in an epidural steroid injection?

Most epidural steroid injections combine two types of medications: a short-acting anesthetic that numbs the area and a long-acting corticosteroid that reduces inflammation. These medications wear off over time, although the associated pain relief can last for several weeks or even several years. Some patients find that injections provide a greater amount of pain relief than oral medications, which treat the entire body rather than a specific source of pain.

The difference between diagnostic and therapeutic injections

When used for diagnostic purposes, the injections are placed near a specific nerve that is thought to be the source of a patient’s pain. X-rays are used to ensure that the nerve is targeted accurately. If the injection leads to significant and immediate pain relief, the targeted nerve is likely to be the cause of the patient’s symptoms.

When used as a form of neck or back pain treatment, epidural steroid injections are delivered into the part of the spine closest to the affected nerve. This may be the cervical spine (the neck), the thoracic spine (the middle of the back) or the lumbar spine (the lower back). Some conditions that can be treated with epidural injections include:

  • Spinal stenosis
  • Sciatica
  • Herniated discs
  • Degenerative disc disease
  • Pinched nerves

If recommended by a patient’s physician, several injections can be provided in a series. However, most medical professionals advise a maximum of three injections per year. Other nonsurgical treatments, such as prescription muscle relaxers, physical therapy and lifestyle changes, may be used to supplement the pain-relieving benefits of epidural steroid injections and help a patient resume daily activities.

How long does it take for epidural steroid injections to provide relief from neck or back pain?

Epidural steroid injections deliver long-acting anti-inflammatory medications directly into the epidural space that surrounds the spinal cord. These medications can reduce swelling and inflammation around compressed spinal nerves. This, in turn, can alleviate localized and radiating pain, muscle weakness, numbness and tingling sensations.

When will the medication take effect?

The injection procedure, which involves inserting a needle through the skin and into deeper tissues, is usually performed in a physician’s office, sometimes with X-ray guidance. Immediately afterward, most people feel about the same as they did before, although they may have some minor soreness around the injection site. This may be due to the mechanical process of needle insertion or irritation from the volume of the medications injected.

Many people begin to notice meaningful pain relief within two to five days after an injection. If the treatment proves to be beneficial, its effects may last for one week up to one year. If necessary (and at the discretion of a physician), a patient can typically receive up to three injections during a one-year period. Any more than that, however, can increase the risk of side effects, such as osteoporosis (weakened bone tissue). That’s because cortisone can inhibit the body’s production of vitamin D, which in turn can interfere with the absorption of calcium that’s essential for strong bones.

Who can benefit from epidural steroid injections?

Overall, it can be difficult for a physician to predict whether epidural steroid injections will be helpful to a patient. In general, pain that travels down the arms or legs tends to respond better to this treatment than pain that is confined to the neck or back. Similarly, arm or leg pain that came on suddenly and recently may respond better than chronic pain.

If you’re exploring your treatment options for neck or back pain, you may want to discuss epidural steroid injections with your physician, who can help you determine if this treatment is right for you.