Cervical Epidural Steroid Injection
The section of vertebrae in your neck is called the cervical spine. One of the leading causes of neck pain is the deterioration of the discs between each vertebra. They can wear down with age and become painful. One of the most effective forms of treatment for chronic neck pain is a cervical epidural steroid, a pain management injection available at Caliber Pain™ in New York City.
The epidural space is a fat-filled ‘sleeve’ that surrounds the spinal sac and provides cushioning for the nerves and spinal cord. Soft discs between the vertebrae cushion and support them. If a disc tears or herniates, irritating fluids may leak out and cause inflammation of the nerve roots and pain. Bone spurs stemming from arthritis can also press against nerve roots and cause inflammation and pain.
Neck Pain Diagnosis and Treatment
A cervical epidural injection can be diagnostic and therapeutic. During this procedure, an anesthetic and a steroid are injected into the epidural space to reduce inflammation.
By placing numbing medicine at the source of neck pain, we can gauge the amount of immediate pain relief you experience. If the pain goes away completely or to a great degree, we can confirm the correct vertebrae or spinal disc and that it is not the symptom of other conditions. Along with the numbing medication, the cervical epidural steroid injection may reduce inflammation and provide long term pain relief.
Injections such as 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 may incorporate regenerative medicine options once the pain and inflammation are well controlled.
Steroids have a very potent anti-inflammatory action that can decrease neck pain. Steroids do not change the underlying condition. They can break the cycle of pain and inflammation, which allows the body to heal. This is a secondary benefit that outlasts the effects of the steroid itself.
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 also want to consider a regenerative option, such as stem cells from bone marrow or adipose tissue or PRP (platelet-rich plasma) for their longer-term healing properties.
If you suffer from neck pain or radiating pain from the cervical spine, a cervical epidural steroid injection may be recommended for diagnosis and treatment. Caliber Pain™ offers steroid injections at our facility in NYC. Contact our office today to schedule an appointment.
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.