Frequently Asked Questions
Epidural Steroid Injection
- What is an Epidural Steroid Injection?
- What is the purpose of it?
- How long does the injection take?
- What is actually injected ?
- Will the injection hurt ?
- Will I be "put out" for this procedure?
- How is the injection performed?
- What should I expect after the injection ?
- What should I do after the procedure ?
- Can I go back to work the next day?
- How long the effect of the medication last?
- How many injections do I need to have?
- Can I have more than three injections?
- Will the Epidural Steroid Injection help me ?
- What are the risks and side effects ?
- Who should not have this injection?
Medial Branch Blocks
- What is a Medial Branch?
- What is the purpose of it?
- How long does the injection take?
- What is actually injected?
- Will the injection hurt?
- Will I be "put out" for this procedure?
- How is the injection performed?
- What should I expect after the injection?
- What should I do after the procedure?
- Can I go back to work the next day?
- How long the effect of the medication last?
- How many injections do I need to have?
- Will the procedure help me?
- What are the risks and side effects?
- Who should not have this injection?
Epidural Steroid Injection
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?
The 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?
The actual injection takes only a few minutes.
What is actually injected?
The 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?
The 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?
No. 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?
It 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?
You 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?
You should be able to unless the procedure was complicated. Usually you will feel some back pain or have a "sore back" only.
How long the effect of the medication last?
The 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?
If 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?
In a 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 cortisone.
Will the Epidural Steroid Injection help me?
It 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?
If 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.
Medial Branch Blocks
What is a Medial Branch?
Facet Joints are innervated or “supplied” by nerves called “medial branches”. These nerves carry the pain signals to the spinal cord and the signals eventually reach the brain, where the pain is noticed.
What is the purpose of it?
If the nerves are “blocked” or “numbed”, they will not be able to carry pain sensation to the spinal cord. It is like temporarily cutting off “wires”. Therefore, if the pain is due to facet joint arthritis, you should have relief from pain and stiffness. Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called “Radio-Frequency Lesioning” and prevent the conduction of pain information for several weeks to months. So, in a way, medial branch block is a temporary and diagnostic procedure.
How long does the injection take?
The actual injection takes only a few minutes. More nerves to be blocked, more time it takes.
What is actually injected?
The injection consists of a of local anesthetic (like lidocaine or bupivacaine) or placebo.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). Therefore, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint. Most patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. Most patients also receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient’s tolerance.
How is the injection performed?
It is done either with the patient lying on the stomach for the upper and low back pain, or for the cervical (neck area) injections – in sitting position or lying on the back, under x-ray control. 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.
What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This may last only for a few hours. Your pain will return and you may have a “sore back or neck” for a day or two. This is due to the mechanical process of needle insertion. It is very important for you to keep a track of your pain and stiffness for the next 2 to 12 hours following injections. Your response to the injections will determine if the facets are the cause of your pain or not.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform your usual activities as tolerated.
Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.
How long does the effect of the medication last?
The immediate effect is from the local anesthetic injected. Depending upon the medication injected, it can last from 2 hours to 8 hours. Of course, if the facet joints are not the source of your pain, you may not have much relief.
How many injections do I need to have?
Usually one session is enough to determine if the facet joints are the most likely source of your pain or not. However, the “placebo response” can be as high as 30 to 40 % and some patients may be recommended to have repeat diagnostic injections. In addition, “False Positive” responses can occur. Evidence based guidelines recommend two sessions.
Will the procedure help me?
If the pain is originating mostly from the facet joints, you should benefit from this procedure on a temporary basis. Some do get a “placebo response” and others may get a “False-Positive” response. Please remember that these are diagnostic injections only and last only for a few hours. These are done to determine if the pain is coming from the facet joints or not, and if the pain is coming from the facet joints, we will recommend “Radio-Frequency Lesioning” – which will “numb” the same nerves for many weeks to months.
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 risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc. Fortunately, the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®), or if you have an active infection going on, you should not have the injection.
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