Steroid Injection FAQs
What is an Epidural Steroid Injection?
Epidural Steroid Injection is an injection of long lasting
steroid ("cortisone") in the Epidural space – that is the
area which surrounds the spinal cord and the nerves coming
out of it.
What is the purpose of it?
steroid injected reduces the inflammation and/or swelling of
nerves in the Epidural space. This may in turn reduce pain,
tingling & numbness and other symptoms caused by nerve
inflammation / irritation or swelling.
How long does the injection take?
actual injection takes only a few minutes.
What is actually injected?
injection consists of a mixture of local anesthetic (like
lidocaine or bupivacaine) and the steroid medication (triamcinolone
– Aristocort® or methylprednisolone – Depo-medrol®).
Will the injection hurt?
procedure involves inserting a needle through skin and
deeper tissues (like a "tetanus shot"). So, there is some
discomfort involved. However, we numb the skin and deeper
tissues with a local anesthetic using a very thin needle
prior to inserting the Epidural needle. Also, the tissues in
the midline have less nerve supply, so usually you feel
strong pressure and not much pain. Most of the patients also
receive intravenous sedation and analgesia, which makes the
procedure easy to tolerate.
Will I be "put out" for this procedure?
This procedure is done under local anesthesia. Most of the
patients also receive intravenous sedation and analgesia,
which makes the procedure easy to tolerate. The amount of
sedation given generally depends upon the patient tolerance.
How is the injection performed?
is done either with the patient sitting up or on the side.
The patients are monitored with EKG, blood pressure cuff and
blood oxygen monitoring device. The skin in the back is
cleaned with antiseptic solution and then the injection is
carried out. After the injection, you are placed on your
back or on your side.
What should I expect after the injection?
Immediately after the injection, you may feel your legs
slightly heavy and may be numb. Also, you may notice that
your pain may be gone or quite less. This is due to the
local anesthetic injected. This will last only for a few
hours. Your pain will return and you may have a "sore back"
for a day or two. This is due to the mechanical process of
needle insertion as well as initial irritation form the
steroid itself. You should start noticing pain relief
starting the 3rd day or so.
What should I do after the procedure?
should have a ride home. We advise the patients to take it
easy for a day or so after the procedure. Perform the
activities as tolerated by you.
Can I go back to work the next day?
should be able to unless the procedure was complicated.
Usually you will feel some back pain or have a "sore back"
How long the effect of the medication last?
immediate effect is usually from the local anesthetic
injected. This wears off in a few hours. The cortisone
starts working in about 3 to 5 days and its effect can last
for several days to a few months.
How many injections do I need to have?
the first injection does not relieve your symptoms in about
a week to two weeks, you may be recommended to have one more
injection. Similarly If the second injection does not
relieve your symptoms in about a week to two weeks, you may
be recommended to have a third injection.
Can I have more than three injections?
six month period, we generally do not perform more than
three injections. This is because the medication injected
lasts for about six months. If three injections have not
helped you much, it is very unlikely that you will get nay
further benefit from more injections. Also, giving more
injections will increase the likelihood of side effects from
Will the Epidural Steroid Injection help me?
is very difficult to predict if the injection will indeed
help you or not. Generally speaking, the patients who have
"radicular symptoms" (like sciatica) respond better to the
injections than the patients who have only back pain.
Similarly, the patients with a recent onset of pain may
respond much better than the ones with a long standing pain.
Also, the patients with back pain mainly due to bony
abnormality may not respond adequately.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with
any procedure there are risks, side effects, and possibility
of complications. The most common side effect is pain –
which is temporary. The other risk involve spinal puncture
with headaches, infection, bleeding inside the Epidural
space with nerve damage, worsening of symptoms etc. The
other risks are related to the side effects of cortisone:
These include weight gain, increase in blood sugar (mainly
in diabetics), water retention, suppression of body’s own
natural production of cortisone etc.
Who should not have this injection?
you are allergic to any of the medications to be injected,
if you are on a blood thinning medication (e.g. Coumadin),
or if you have an active infection going on, you should not
have the injection.