Caudal Epidural Steroid Injection
Chronic pain in the lower region of the back is one of the most commonly reported health problems among adults. The causes of lower back and leg pain can be sciatica, herniated discs, bone spurs or other back problems. At Caliber Pain™, we offer caudal epidural steroid injections for pain relief at our medical facility in New York City.
The nerves that run from your spinal cord out to your back and legs have roots that can get irritated and inflamed by the fluids leaking from damaged discs or other issues. The lowest portion of the epidural space, where nerve roots are located, is the area we treat.
A caudal epidural steroid injection can help reduce inflammation and alleviate pain in the lower back and legs. These types of injections take very little time, and there is a rapid onset of long-lasting relief. The injection of medication directly into the joint may be a solution, both for pain relief as well as to help diagnose the source of your pain.
Injections for Diagnosis and Pain Relief
By placing numbing medicine into the area closest to your pain, we can gauge the amount of immediate relief you experience. If the pain goes away completely or to a great degree, we can confirm the source of pain and that it is not the symptom of another condition. Along with the numbing medication, a steroid is administered to reduce inflammation and provide long term pain relief.
Injections like corticosteroids, hyaluronic acid, platelet-rich plasma or stem cells are options for pain relief and healing damaged soft tissues. Our doctor will thoroughly discuss the benefits of each modality. Some treatment protocols incorporate regenerative medicine options once pain and inflammation are well controlled by steroids.
What to Expect
Caliber Pain™ performs this procedure on an outpatient basis in a treatment room equipped with ultrasound guidance or fluoroscopic x-ray technology.
The medicines will spread in the epidural and caudal spaces. The steroid targets inflammation and the anesthetic disrupts pain signal transmission. The steroids are specifically injected into the areas where serious inflammation has been confirmed.
A caudal steroid injection is a non-surgical procedure that can take as little as 15 minutes in an outpatient setting. Patients who receive a caudal steroid injection typically experience immediate improvements or feel as if their pain has been completely alleviated. Immediate relief may dissipate as the local anesthetic wears off. Longer-term relief usually begins in two to three days, once the steroid begins to work.
The benefit can vary by individual. For some, the relief lasts several months or longer. If the treatment works for you, you can have periodic injections to stay pain-free. You may want to consider regenerative options, like stem cells from bone marrow, adipose tissue or PRP (platelet-rich plasma), for their longer-term healing properties.
Sciatica, herniated discs, bone spurs and other back pain can be treated with caudal epidural steroid injections. If you are interested in learning more, contact Caliber Pain™ at our clinic in Midtown Manhattan.
Frequently Asked Questions About Epidural Steroid Injections
If you suffer from debilitating neck or low back pain, your physician may have recommended an Epidural steroid Injection as part of your treatment plan. There are a lot of misconceptions about this procedure, and the Pain Specialists at Caliber Pain have addressed some of these below.
What is an Epidural Steroid Injection?
An Epidural Steroid Injection is a safe, well-established procedure that classically treats radicular neck or back pain; that is, neck pain that radiates down the arm(s) or back pain that radiates down the leg(s). Using x-ray guidance, an injection of anti-inflammatory medication is placed in the epidural space just outside of the spinal canal. This acts to decrease inflammation and swelling, irrigate away painful chemicals (such as cytokines), and relieve pressure on the nerves of the spine.
Some diagnoses that this injection can treat are the following:
- Neck Pain/Back Pain
- Disc Herniation(s)/Disc Bulge(s)
- Cervical Radiculopathy
- Lumbar Radiculopathy
- Degenerative Disc Disease
- Spinal Stenosis
Do Epidural Steroid Injections Work?
According to the studies, between 50-90% of well-selected patients will find effective pain relief with Epidural Steroid Injections, lasting from several weeks to up to 1 year, with the average being several months. Those with pain that has started within the last 3-6 months and those with pain radiating down the arm(s) or leg(s) are found to benefit from the most relief. This relief can translate to improved quality of life and mobility, improvements in mood/mental health, a decrease in the need for opioid medications, and an ability to better participate in physical therapy, amongst other things.
There can be many factors that influence how well this injection can help, ranging from a proper diagnosis, the type of epidural (interlaminar, transforaminal, caudal), participation in a proper physical therapy program, and the functional habits of the patient (type of job if working, posture, weight gain, diet, etc). Sometimes, the first injection can provide >50% pain relief, and a second injection can be administered thereafter to obtain further benefit.
Are they Safe? What are the Side Effects?
An Epidural Steroid Injections is a safe procedure that has been performed for about 70 years by doctors all around the world. Thousands of these injections are performed in America every single day.
Most commonly, some can experience mild soreness at the injection site and the temporary steroid side-effects (increased energy, increased appetite, changes in sleep quality, changes in blood sugar or blood pressure). Rarely (less than 1%), some may develop a temporary, postural headache.
The chances of a serious complication such as nerve injury, paralysis, stroke or death are extremely rare, thought to be between 1 in 10,000 to 1 in 100,000 as per some studies.
These risks should be weighed against the risks of not treating chronic pain, specifically related to opioid (narcotic) use/abuse, the depression/mental health effects of living in chronic pain, lost work productivity, and others. In 2017, the CDC reports that over 17,000 Americans died from the overdose of Prescription Opioid Medications, and over 47,000 died due to any Opioid overdose.
The US Pain Foundation reports those with chronic pain consider suicide twice as often. US data indicate that around $600 Billion is lost annually in America due to lost work productivity and healthcare dollars related to chronic pain.
Do Epidural Injections Hurt? How long is the procedure and recovery time?
Epidural Steroid Injections typically take only a few minutes to perform under trained hands using x-ray guidance. The doctor gives numbing medicine (i.e. lidocaine) in the skin first to minimize pain during the procedure, so most only feel a bit of “pressure” in the skin after this sets in.
Many patients opt to receive IV sedation during the procedure to maximize comfort. In this scenario, this is a light “twilight” type of anesthesia with the patient still breathing on their own, similar to what one may receive for a colonoscopy. IV sedation anesthesia is associated with higher patient satisfaction and provides superior working conditions for the doctor due to relaxed muscles and decreased patient movement during the procedure.
What can I expect after the Procedure?
Patients typically feel comfortable after the procedure as the numbing medicine will be active in the skin and tissues for several hours, but mild soreness can be expected for the first couple of days. If you received IV sedation anesthesia, you can usually go home after 30 minutes but cannot operate a vehicle or drink alcohol for 24hrs. Patients usually go back to light activity by the next day.
The main decrease in pain is due to the steroid effect which typically takes 3-5 days to reach its peak, (although this can sometimes take 7-10 days). The duration of the relief can last anywhere from several weeks to up to 1 year, but usually for several months. This relief can be prolonged with physical therapy and other lifestyle modifications (as detailed under “Do Epidural Steroid Injections Work?”).
If you are suffering from chronic neck pain or back pain and would like a consultation with one of our Pain Specialists at Caliber Pain, call (212) 203-5987. During the COVID-19 (Coronavirus) Pandemic, we are conveniently offering Virtual Consultations.