Steroid Injections for Back Pain: Top Things to Know

Lower back pain affects about 620 million people globally and that number is projected to increase to 843 million by 2050, according to the World Health Organization. It is the single leading cause of disability worldwide.

Epidural steroid injections are one of the most common medical procedures to address back pain. These injections have been used for more than 50 years, due to their effectiveness and safety.

In most cases, the procedure does not cure the cause of the back pain, but it can provide quick, short-term relief. The injections are often part of a more comprehensive treatment program that includes exercise, stretching techniques and physical therapy.

Delivering pain medicine quickly

With an epidural injection for back pain, an anesthesiologist or certified registered nurse anesthetist uses a syringe to inject anti-inflammatory medication into the fat-filled epidural space around the spinal nerves. The medication is usually a steroid.

In essence, it is a way to deliver pain medicine quickly into the area from which the pain is emanating.

The epidural space is located where the bones and discs of the spine encircle the nerves and spinal cord. The disc tissue in this area can be impacted by pressure, swelling and inflammation, creating significant pain and impaired movement.

Dexamethasone, betamethasone, methylprednisolone, and triamcinolone are the most used steroids in epidural injections. These medications reduce inflammation and swelling.

People who suffer from lumbar disc herniation, degenerative disc disease, lumbar radiculopathy (compressed nerves), sciatica, lumbar spinal stenosis and other common back ailments can be candidates for spinal epidural injections.

What to expect during the procedure

Epidural injections are typically done in a hospital or outpatient clinic. The procedure takes only a few minutes and patients can go home the same day.

Typically, the process is as follows:

• The patient is given a gown to change into.

• If able, the patient lies face down on an X-ray table. If back pain prevents that positioning, the patient can sit up or lie in a curled position.

• The area of the back where the needle will be inserted is cleaned. Medication may be used to numb the area and some patients may be given a sedative to help them relax.

• The healthcare provider inserts a needle into the epidural space in the back. An X-ray machine that produces real-time images will likely be used to help the provider pinpoint the exact location to insert the needle.

• The epidural space is injected with a mixture of steroid and numbing medicine. This concoction works to decrease swelling and pressure on large spinal nerves and helps reduce pain. The patient is advised to remain very still during the procedure so that the provider can insert the needle at precisely the right spot.

• After being monitored for about 20 minutes after the injection, the patient is allowed to go home.

Do steroid injections work for back pain? Are there complications?

Surgery is one option that has proven to be effective for people with back problems such as disk herniation and canal stenosis. However, it is not usually considered as the first option. Injections are less invasive and are thought to be a better initial approach to the problem.

According to the National Institutes of Health, epidural steroid injections seem to be safe and quite effective in relieving back pain attributed to various back conditions, especially in the short-term.

However, the injections are not a silver bullet. They are not 100% effective, and they are usually not a permanent solution.

In many cases, the injections start working to relieve pain within a few days of the procedure. The relief can last several days to a few months or longer, depending on the patient and the severity of the back condition.

For some patients, the pain relief from the injection is significant enough to allow them to participate in rehabilitation exercises to address the cause of the back pain.

That’s why doctors often recommend simultaneous treatment such as an exercise program to improve or maintain spinal mobility (stretching exercises) and stability (strengthening exercises), according to the American Academy of Orthopedic Surgeons.

Risks and complications from epidural steroid injections are rare. They include lightheadedness during and shortly after the procedure, infection, rash, and bleeding if a blood vessel is accidentally damaged during the injection.

Most doctors will limit patients to two to four injections per year. Getting too many of them can weaken spinal bones and the muscles around them.

Conclusion

Studies indicate about 85% of the population experiences back pain at some point in their lives.

When thinking about seeking relief from the often-debilitating medical issue, it’s important to minimize the use of opioid medications, which are not considered the answer to chronic pain and can lead to addiction.

Before loading up patients with powerful rugs for back pain or scheduling surgery, health care professions may recommend an epidural steroid injection. The procedure can relieve pain so that patients can return to normal activities and engage in physical therapy.

Ochsner Health offers world class interventional pain management right here in Louisiana. Our nationally and internationally recognized multidisciplinary team of experts offers innovative, evidence-based treatments to safely and effectively reduce pain so that patients can get back to doing what they love.