Epidural Steroid Injection FAQs

  1. What is an epidural steroid injection?
  2. What should I do before the procedure?
  3. What can I expect?
  4. How is the epidural steroid injection done?
  5. When will I have some relief of pain?
  6. What should I do after the procedure?
  7. What are the risks?
  8. How long will it last?
  9. What if I have further questions?

1. What is an epidural steroid injection?
This is a conservative procedure to attempt to control pain due to swollen and irritated nerve roots in the spine. These nerve roots can become irritated from bulging (herniated) or leaking discs, or from other processes causing the nerve canal to become narrowed.
 
The epidural space is the area outside of the sack which contains the spinal cord and spinal fluid. In that space a small amount of steroid is injected. This medication improves pain control by reducing the swelling and irritation surrounding the nerve roots.

2. What should I do before the procedure?
If you are scheduled to have an epidural steroid injection in your upper back or neck or arm pain, there are no restrictions regarding eating or drinking. You are also not required to have a driver.
 
If you are taking a blood thinner such as coumadin, Plavix, or Aggrenox, or more than one small aspirin tablet per day, you will need to stop taking this medication so that your blood clotting is normal at the time of the injection. Please contact your primary care provider before you discontinue this medication. Our clinic will work with you on the exact instructions for your specific medication. 

3. What can I expect?
In the Pain Clinic, a doctor will assess your pain, take a brief medical history, and perform an examination focused on your pain symptoms. The risks and benefits of the procedure will be discussed, and your questions answered.
 
4. How is the epidural steroid injection done?
You will be asked to lie on your stomach on a specially padded bed. The procedure will be done under sterile conditions and with X-ray guidance. The doctor will numb a small area of your skin with local anesthetic medication. The doctor will then guide a small needle through the skin to locate the epidural space and inject the steroid close to the nerve roots that are thought to be causing you pain. The procedure should be painless, except for the slight stinging of the numbing medicine at the very beginning of the procedure.
 
5. When will I have some relief of pain?
If the epidural injection is effective for you, an improvement of your symptoms will occur between a couple days to a week after the injection. Not everyone improves with an epidural steroid injection. It is not uncommon to have a very slight increase of pain for about 12 to 18 hours after the procedure.

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6. What should I do after the procedure?
There are no special instructions for resting or lying flat after the injection. You may resume your usual activities in anticipation of pain relief which usually starts within 48 hours. You may shower or bathe anytime after the procedure without concerns

7. What are the risks?
The risks of an epidural injection are similar to any other injection. People who have no infections or bleeding problems are at extremely low risk of these problems being caused by an epidural. Damage to nerves is extremely rare and is related to bleeding in almost all cases. In less than one in 100 cases, the epidural needle enters the sac containing the spinal fluid. If this occurs you may experience a headache starting 24 hours after the procedure. This is not dangerous, but can be uncomfortable. Your doctor would tell you if this happened during the procedure, so you need not worry about it unless advised.

8. How long will it last?
Pain relief from an epidural steroid injection can be long lasting. However, some people receive only a brief period of relief, or no relief at all. A nurse from our clinic will contact you within two weeks to determine the results of your injection. Not uncommonly, up to three injections are provided in a series to maximize the effects. Sometimes a different approach at treating the affected nerve is used if the first approach is not successful.

9. What if I have further questions?
You can ask the doctor at the time of your appointment or call the Anesthesiology Pain Clinic at (206) 223-7582.

Things to call the Anesthesiology Pain Clinic about after the injection:

  1. Any new pain or weakness in your back, legs or arms that begin after you get home.
  2. Fever (above 101 degrees) or severe headache.
  3. New difficulty with bowel or bladder control

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