Epidural Steroid Injections

By reducing inflammation, epidural steroid injections (ESIs) are used to  relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the vertebrae and the outer membrane that covers the spinal cord (the dura). As a result, they provide more direct and effective pain relief than oral medications.

Candidates

Candidates for epidural steroid injections typically have back or neck pain, and pain radiating down the arms or legs. Pain relieved by Epidural Steroid Injections can be the result of many conditions, including the following:

Epidural steroid injections can be used alone to provide pain relief, or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Dr. Campbell's approach is zero pain as fast as possible for as long as possible. He has found through 25 years of pain management experience, that Epidurals work best with weekly sessions, for 2-4 weeks. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist a physician in developing an appropriate treatment plan.

Procedure

Epidural steroid injections are administered by Dr Campbell by the transforaminal or interlaminar approach. Depending on your clinical diagnosis or response to previous treatments Dr. Campbell will decide which approach is best for you. Typically, they are administered in an outpatient facility, while you are sedated.  Fluoroscopy is utilized to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although a patient may feel pressure at the injection site. The injection procedure takes only a few minutes. In most cases, the patient experiences immediate pain relief due to the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation, the patient should feel a significant, if not total, alleviation of pain. The patient can usually resume normal activities the day after the procedure.

Risks

Epidural steroid injections are a safe form of treatment, although, in rare instances, they can cause headaches, bleeding, infections, nausea or vomiting, allergic reactions or nerve damage. Patients who are pregnant, have infections, or suffer from chronic bleeding disorders are not candidates for epidural steroid injections. ESIs can temporarily elevate blood pressure and blood sugar, and cause mood swings, so patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment.

Transforaminal Epidural Steroid Injections

A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The procedure is done in an outpatient operating suite, with anesthesia, and X-Ray or flouroscopy Immediate pain relief is found because of the injection of local anesthesia or numbing medicine, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with pain that radiates through the arms or legs rather than just back or neck pain. Dr. Campbell typically does weekly injections for 2-4 sessions, with the goal of zero pain for as long as possible