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Epidural Steroid Injections for Relief From Radicular Pain
Epidural Injections are an integral part of the non-surgical management of radicular pain from spine disorders. Radicular pain is often described as a sharp, burning, or shooting pain that originates from the low back and travels down to the lower extremities (or from the neck to the upper extremities). The pain is caused by either a protruding/herniated disc or spinal/foraminal stenosis, which irritates a nerve root. The epidural injection is used to relieve nerve root irritability, by administering a small volume of steroid, a strong anti-inflammatory agent, close to the nerve root, thus minimizing the effects of steroids on the whole body.
Epidural injections have been used since 1952 and are recommended for diagnostic and therapeutic purposes. This type of injection is normally considered after nonsteroidal anti-inflammatory drugs and/or physical therapy have failed to provide adequate pain relief.
Epidural injections have been proven to be effective in relieving pain. For those who receive the injection within three to six months from the onset of pain, response rates can be as high as 70-90%. This response rate may lower for patients who have had prolonged pain. Other factors associated with a decreased response include age over 60 years, smoking, and a history of back surgery. Repetition of an injection depends on the response to the treatment. For acute radicular pain symptoms, 3-4 Epidural Injections may be performed in total (usually one injection every 3-4 weeks).
Complications from Epidural Steroid Injections are extremely rare but include headache, nerve injury and infection. Side effects may include a temporary elevation in blood sugar and fluid retention. More commonly, soreness at the injection site or a temporary increase in pain symptoms may be noted after the injection. Patients on anticoagulants or blood thinners must receive clearance from the prescribing physician to stop these medications before the injection can be performed. Blood tests may be done before the procedure to verify that blood clotting is within a safe range. However, medications for high blood pressure or diabetes should be continued.