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An epidural steroid injection is a non-surgical treatment typically used
to alleviate chronic low back and/ or leg pain. While the effects from the
injection tend to be temporary, providing relief from pain for one week to
one year, an epidural can be very beneficial for patients during an episode
of severe back pain. One important use is to provide sufficient pain relief
to allow the patient to start (or progress in) a rehabilitation program.
Effectiveness
An epidural injection significantly reduces pain for approximately 50% of
the patients that receive one. It works by delivering steroids directly to
the painful area to help decrease the inflammation that may be causing the
pain. It is thought that there is also a flushing effect from the injection
that helps remove or “flush out” inflammatory problems from
around the structures that may cause pain.
As a disc degenerates, the inner core of the disc can extrude—or
herniate—back into the spinal canal. The herniated disc material can
irritate the nerve (A), which can cause pain to radiate down the path of the
nerve—from the lower back through the buttocks and into the leg or
even into the foot.
What is an epidural?
An epidural is an injection that delivers steroids directly into the
epidural space. The epidural space is the space between the dura mater (a membrane)
and the vertebral wall and is filled with fat and small blood vessels. It
is located just outside the dural sac. The dural sac surrounds the nerve
roots and cerebrospinal fluid (the fluid that the nerve roots are bathed
in).
There are often inflammatory factors and other substances that generate
pain (e.g. substance P) that are associated with lumbar disc herniation and
this inflammation can cause significant nerve root irritation and swelling.
Steroids (corticosteroids) have been shown to reduce inflammation by
inhibiting the production of substances that cause inflammation; the
epidural injection can be highly effective because it delivers the
medication directly to the site of inflammation.
When is an epidural recommended?
In general, epidural injections are used to help provide pain relief to
enable patients to progress with their rehabilitation. Individuals who have
less pain and feel more comfortable are generally able to work on the
active therapies—such as stretching, strengthening and pain relief
exercises and low impact aerobic conditioning—that are critical in
rehabilitating the lower back.
Several common conditions—including lumbar disc herniation,
degenerative disc disease, and lumbar spinal stenosis—can cause
severe acute or chronic low back and/or leg pain. For these and other
conditions that can cause chronic pain, an epidural steroid injection may
be an effective non-surgical treatment option.
What are the benefits?
The benefits of the epidural steroid injections include a reduction in
pain, primarily in leg pain. If a patient does not experience any pain
relief from the first injection, further injections will probably not be
beneficial. However, if there is some improvement in pain, one to two
additional injections may be recommended.
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