Epidural Steroid Injection: What You Should Know

For those with lower back and leg pain and not finding any relief with conservative treatments such as physical therapy, massage, chiropractic treatments, acupuncture, over the counter and prescription medications – an epidural steroid injection (ESI) might be a good treatment option for you.

With an ESI, steroids and a local anesthetic are delivered directly into the epidural space of your spine via a needle.

Here is a short video on how it’s done:

I was 23 years old when I herniated three lower lumbar discs in 2003. I have since had one artificial disc replacement surgery and many procedures – ESI’s included. I’ve had great successes with ESI’s that have lasted several months. I’ve had some that haven’t worked at all. I’ve had some that have only worked for a few weeks. It is literally a hit or miss with me.

Remember, EVERYONE reacts differently and EVERYONE’s experiences will be different.

If you are scheduled for an ESI, your healthcare provider will give you specific instructions on what to expect before and afterwards. Since I’ve had so many over the years and with various doctors and at various clinics, I thought that I’d share what I know from a patient’s perspective:

Preparation

1. Ask if you will be sedated

ESI’s are often performed without sedation but you can most definitely request it. If needles make you squeamish or the thought of just having the procedure done makes you uneasy, perhaps this might be a good option for you.  Also, some patients cannot lay comfortably on their sides or on their stomachs due to pain. Sedation will allow you – rather, the medical staff help you to move into these positions so the procedure can be performed. These are things that will need to be discussed with your doctor.

faint

I have had the procedure both with and without sedation and I find that the procedure itself is so quick that the sedation wasn’t necessary. The sedation always made me very nauseous. Again, this is my experience and will vary with each individual.

This is completely up to you and your doctor and your comfort level. Do what makes YOU comfortable.

2. Arrange for a ride

If you’re receiving sedation, you will need to have someone drive you home. If you’re not, doctors still do recommend that you do have someone drive you home after the procedure.  Even though you’ll be able to move around after, you might feel sore afterwards. ESI’s affect everyone in different ways. Sometimes my lower limbs felt numb and very heavy – like someone had poured cement in them. Honestly, it’s better to err on the side of caution.

Maybe ask for someone who knows how to drive!
Maybe ask for someone who knows how to drive! Safety first!

Every pain clinic that I’ve ever been to have had my ride sign me out before I have been allowed to leave the premises. I am not sure if this is mandatory / legality for all clinics. Check with your establishment – but you should arrange for a ride.

3. Medications, special considerations if you are diabetic, and special considerations if you have a mental illness

Your doctor will go over your current medications with you – prescription and over the counter. Certain medications such as blood thinners and anti-inflammatories may need to be discontinued a few days prior to the procedure. Your doctor will advise you.

If you have diabetes, the steroid can increase your blood sugar levels for 7 -12 days after the injection is given. Your doctor will advise you of your aftercare.

If you have a mental illness please make the doctor performing the procedure aware of the medications you are taking. It is also a good idea to notify your psychiatrist/doctor/therapist about the upcoming procedure. Steroids can increase your anxiety and can also interfere with your sleep. They will want to monitor for any changes in your mood.

medications

4. Eating or drinking

You will be able to eat and drink normally several hours prior to the injection. Your doctor will advise you.

5. Clothing and jewelry

It’s best to go to the procedure wearing comfortable loose fitting clothes.  I felt bowled over after some of my injections and it was so nice being able to come home and just roll into bed.

Leave your jewelry at home. They will make you take it off anyways and you don’t want to lose them!

6. Work

Doctor’s do recommend that you rest the remainder of the day after the injection. If you need a note from the doctor to take the day off, now is a good time to ask.

You may experience an increase in pain after the injection which may also continue for the next day or two. It all depends. Everyone reacts differently. Depending on what you do for a living, you’ll have to speak with your doctor on what type of restrictions he or she feels you should be on or if any.

doctornote

7. Get an ice pack and heating pad

If you don’t have one at home, now is the time to get one. Some people do experience a flare up of pain after these injections. Ice is a great way to combat the increased pain within the next 48 hours. After that, a heating pad can be used.

Aftercare

You will be monitored for 30 minutes to an hour after the procedure is completed.

1. You may feel fantastic

Pain relief might be almost immediate and that’s a wonderful thing! But before you go doing cartwheels and start lifting heavy loads of laundry, you should know that this very temporary pain relief is due to the local anesthetic mixed in with the steroid. That effect will wear off in a few hours. The steroid actually takes around 3 – 7 days (for me it takes more like 7 days) for it to start working. You have to be really patient with it.

Don't run out of the doctor's office doing this just yet!
Don’t run out of the doctor’s office doing this just yet!

2. You may also feel terrible.

Pain at the injection site is very common. You may also feel an increase in pain (a pain flare). You can apply ice to the site for 20 minutes on and 20 minutes off to decrease the pain for the first 48 hours when needed. After that you can use heat.

Continue to use your pain medications as prescribed by your doctor.

Try to limit your activities as much as possible during this time. Take it easy.

be gentle

I typically get an increase in my pain symptoms following an injection. Again, EVERYONE reacts differently. The pain usually subsides within a few days — again this is based on my experience. If you have concerns with any increase in pain, contact your doctor.

3. No baths (or soaking in water) for 48 hours

Soaking the injection site will increase your risk for getting infection. You can take showers. After 48 hours you can resume taking baths. If your doctor applies a bandage over the injection site, you can remove it the following day.

bath

*Iodine will be ALL OVER THE PLACE – my pain specialist bathes my back in the stuff and I come out looking like half an Oompa Loompa from Charlie And The Chocolate Factory.

The iodine will fade from your skin over a few days with washes of warm water and soap. If it bothers you and you want to get rid of the stain pronto, soak a cotton ball in rubbing alcohol and then apply the cotton ball to the stain on your skin. The iodine stain should disappear. Then wipe away with warm soapy water. Be sure not to get the rubbing alcohol near the injection site or it will burn.

4. Resuming regular activities

After 24 hours you can resume your regular activities.  Remember that it takes up to 7 days for the steroids to work so make sure that you are taking your time easing back into your regular routine.

laces

 

Note: You should seek medical care if you develop any of the symptoms after an ESI (according to emedicinehealth.com):

  • signs of an allergic reaction – itching, difficulty breathing (wheezing), swelling, rash, hives
  • numbness, tingling, inability to move legs
  • high fever
  • headache
  • dizziness
  • increased pain

My back will never be structurally the same nor will I ever be completely pain free however, these pain management options such as ESI’s do give me an improved quality of life of which I am grateful for.

I hope that this will help you if you are going to try an ESI as a pain management option.

Best of luck to you!

 

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