Epidurals for Back Pain
In the treatment of back pain a conservative treatment approach is often followed prior to any invasive procedures. These procedures can be in the form of chiropractic care, massage, physical therapy and in more painful conditions pain management, in particular epidural steroid injections.
The utilization of epidurals is most often employed when a person has back pain with referred pain in a distribution described as radicular in nature. The term is used to describe an inflamed or irritated nerve root in the spine. This can create pain in the distribution of that nerve root as well as weakness and numbness.
This “radicular” pattern can be seen in both the legs and the upper extremities depending on where the irritated nerve root is. If it is in the lower back it is called lumbar radiculopathy and can affect the legs if it is in the neck or cervical spine it is called cervical radiculopathy and can affect the upper extremities or arms. Epidural injections are used to deliver medication to the irritated and painful nerve roots.
In the utilization of epidurals for back pain there are certain conditions most frequently treated with this technique. They are as follows.
- Herniated Discs
- Spinal Stenosis
- Degenerative Disc Disease
While epidurals steroid injections have been shown to be effective for the above conditions, it’s important to note that epidurals are not a long term solution. The medication used is a steroid and provides powerful local anti-inflammatory properties locally to the nerve. However, there is nothing curative about the procedure.
The Epidural Procedure
Epidurals are administered by injecting a medication in to the epidural space surrounding the spine. This is the areas where the injured nerve roots are. Typically a local anesthetic is used in the form of lidocaine or some other medication and a longer lasting steroid. The steroid is used to decrease the inflammation irritation of the painful nerve and the anesthetic addresses the reflex muscle spasms and pain signals sent by the pain sensitive nerves.
The utilization of this procedure is primarily for the interruption of pain and to allow the patient to regain mobility and to participate in a more structurally oriented program of rehabilitation, returning them to work and back to normal activities of daily living.
There are different forms of epidurals and each is utilized to address a particular clinical outcome. The choice of which type of epidural you get is a combination of your clinical presentation, your exam and MRI findings and your doctor’s preference. The difference in these variations is primarily needle placement and the target of the procedure be it 1 or more nerve roots.
Types of Epidurals for Back Pain
Intralaminar Epidural- This may be the most common type of epidural and was utilized most frequently prior to the invention of the c-arm for x-ray guided injections. It entails numbing the skin and inserting the needle in the midline of the lower back between the spinous processes into the intralaminar space. This procedure puts a large amount of medication into the epidural space and can affect multiple nerve roots and both sides. Long term the procedure is limited in value, however it can provide good short term relief.
Transforaminal Epidural-This procedure requires a numbing of the skin again; however the needle placement is lateral and enters through the side of the vertebrae and is aiming primarily for one nerve root in one side. Some doctors prefer this approach because it is thought to be more specific and targeted. It is also utilized if scar tissue or hardware is present, because the needle cannot pass through these structures posteriorly. Again this procedure is good for short term and medium range pain relief, but is best if a multi-specialty program is initiated.
Caudal Epidural- The skin is once again numbed and the needle is then introduced near the tailbone. This approach introduces a catheter into the epidural space and a large bolus of steroid is introduced. This can be an effective approach is someone has severe spinal stenosis or arthritis and needle placement is difficult due to the increased amount of degeneration. Again short term relief is common, however long term benefits are still not typical.
Do Epidurals help?
In today’s climate of back pain treatment, epidurals are performed quite commonly. Studies have shown mixed findings related to their utilization. While they do in most cases provide temporary pain relief, they do not offer any long term benefits. Most often epidurals are given in three’s. If pain relief is achieved to some degree another and often a third injection will be administered. If there is no relief after the first injection, most doctors will not perform a second. Although some studies have shown better and longer lasting pain relief with more than one injection.
Epidural Risks and Side Effects.
Even with their pain relieving power, spinal injections may have some undesirable effects. These side effects may include bleeding, infection, post-dural puncture headache, and nerve damage. There are also side effects related to the medications used for the procedure. These can include increased blood sugars, weight gain, arthritis, stomach ulcers, and a suppression of the immune system. The possibility of these side effects warrants a thorough evaluation by your doctor. If a patient is on blood thinners, has allergies to certain medications, is pregnant or is suffering from an active infection should use caution and let their doctor know of these risk factors.
Epidurals can be a very effective procedure for some people on their road to recovery, however pain relief duration and intensity vary from person to person. Some people do experience long term relief while others none at all. The best plan of attack is to utilize this procedure as an opportunity to participate in other healing strategies to provide ling term relief and recovery. If you found this article helpful as always please share it on Facebook, Twitter or via email