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Lumbar Epidural Steroid Injection

A lumbar epidural steroid injection (ESI) is an injection of a small dose of anti-inflammatory steroid medication into the lower back to relieve pain in your legs or lower back. The medication is injected into an area of fatty tissue surrounding the spinal nerves called the epidural space. This can help reduce back pain from herniated discs and other spinal issues. Caliber Pain™ offers lumbar epidural steroid injections as one of our treatment modalities at our clinic in NYC.

The fluid from leaking, damaged discs is highly irritating to the neural matter and can cause nerves to remit pain signals endlessly. An epidural steroid injection can help control the resulting inflammation, while also “flushing out” the inflammatory proteins and chemicals.

Benefits of Lower Back Steroid Injections

Epidural steroid injections have been used for lower back problems since 1952 and are still an integral part of the non-surgical management of sciatica and lower back pain. Unlike oral steroids and pain killers, epidural injections deliver medication directly to the source of pain. Lower back, or lumbar, steroid injections work by:

  • A steroid, or cortisone, is usually injected as an anti-inflammatory agent.
  • Lidocaine may be used for temporary pain relief. Although primarily used for pain relief, it also acts as a ‘flushing’ agent to dilute the inflammatory chemical or immunologic agents.
  • Saline is used to dilute the local anesthetic or as a ‘flushing’ agent to dilute the inflammatory chemical or immunologic agents.

A lumbar epidural steroid injection (ESI) can be both a treatment and a way to diagnose a specific nerve root problem. By administering numbing medicine in the area, 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 source of the pain. Along with immediate relief from the numbing medication, the steroid can reduce inflammation to provide long-term pain relief. Conditions treated by lumbar ESI:

  • Lumbar disc herniation
  • Degenerative disc disease
  • Lumbar spinal stenosis
  • Compression fractures in a vertebra
  • Cysts on the facet joint or the nerve root that can expand to squeeze spinal structures
  • Annular tear in the outer layer of the disc

Steroids normally take two to three days to begin working but can take as long as one week. You should be able to return to work the day after the procedure.

If you suffer from lower back pain or sciatica, contact our team at Caliber Pain™ today. We offer lumbar epidural steroid injections and other interventional treatments at our medical facility 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
  • Osteoarthritis
  • Spondylosis
  • Spondylolisthesis
  • 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.

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