How does an epidural steroid injection work?
Interventional pain management is referring to a specialized approach that concentrates on the use of minimally invasive techniques in the field of medicine known as pain management.Examples of these techniques are facet joint injections, spinal cord stimulator implants, pain pumps, joint injections, and nerve blocks. Interventional pain management generally refers to the special procedures that are used in the treatment and the management of pain.
Benefits of Interventional Pain Management
The use of these interventional Chicago pain management techniques can benefit patients in the following ways:
The procedures can help to reduce the severity of the pain that is experienced by the patient. They may also help to reduce the amount of time that this pain will be experienced.
They allow the patient to increase the amount of activities that one can engage in, both at work and at home. They will enable the patient to overcome any isolation that one will start to experience socially when they are constantly in pain.
These techniques will help rehabilitate the patient and help them lead their lives with a new perspective – experiencing the pain free feeling that they once had before. The patient will be able to experience an improvement in the quality of their life.
There are a number of disorders and conditions that cause a lot of distress and also great discomfort to patients, who often eventually require interventional pain management.
Examples of the conditions that benefit from the use of interventional pain management include:
- Numerous postsurgical procedures
- Muscle and/or bone pain. Pain in the bones is reportedly less common than pain in the muscles or even pain in the joints. Pain that is caused by cancer which has spread into the bones may not be as blatantly obvious.
- Malignancy. This refers to the tendency of a medical condition, mostly tumors, to worsen to the extent of causing death to the patient. A malignant tumor can spread to the tissues adjacent to it and it can also spread to tissues that are distant from it.
- Chronic pain in the face, mouth, or head. Pain that persists for more than 6 months can be defined as chronic. The medical term used for describing a burning pain in the mouth, whose cause cannot be established, is burning mouth syndrome. The discomfort may be felt anywhere in the mouth. This could be on the gums, tongue, inside the cheeks, lips, roof of the mouth or in the whole mouth. It can appear very suddenly. The sensation is like the one felt when we scald our mouth with hot substances. Headaches can be of many different types. Examples include tension, rebound, cluster, sinus, or even migraine.
- Chronic reflex sympathetic dystrophy
- Post traumatic pain syndrome
- Chronic pain in the lower back and neck. Back pain which lasts for more than 3 months is classified as chronic. This is the most common type of pain felt by most people.
These pain management techniques are another option for patients who are trying to get control over their pain, and they should examine them with their health care provider. These may be a viable solution for those who cannot undergo surgery, choose not to, or have not responded to other treatments. These treatments take a different approach of disrupting the pain signals within the body, which work well for certain conditions..
Epidural steroid injections are particularly effective in relieving the symptoms from conditions that cause inflammation and pain of the spinal nerves such as disc herniations, and serve a dual diagnostic and therapeutic purpose. While the goal of epidural steroid injections is primarily pain relief, they are also used as part of a comprehensive physical therapy and rehabilitation program.
The epidural space refers to the anatomic space on the outermost part of the spinal canal, outside the dura mater. The dura mater is the tough, fibrous material that serves as the covering of the spinal cord, the arachnoid matter, the subarachnoid space, the cerebrospinal fluid, etc. This extradural space contains many important structures such as the spinal nerve roots, fatty tissues, blood vessels, such as sma
ll arteries and the epidural venous plexus, and some lymphatics.
Transforaminal Epidural Injection
The technique involves direct injection of steroids into the epidural space. The most commonly used steroids are dexamethasone, methylprednisone, and other corticosteroids. These are powerful anti-inflammatory drugs that provide relief of symptoms by suppressing the inflammatory response, which relieves the irritation and swelling near the nerve root.
The steroids work by relieving the mechanical and chemical sources of pain. The injection of epidural steroids by a Chicago pain management doctor is usually accompanied by local anesthetics, which affords relief from pain that usually lasts anywhere from one week to a whole year. This makes it very useful in dealing with severe, acute attacks of pain. If this provides adequate pain relief, then you may receive up to three or four series in a one year period.
The procedure is done under a local anesthetic, although a mild sedative can be given to relax the patient. Prior to the procedure, the procedure site is scrubbed with a sterilizing solution such as povidone-iodine or chlorhexidine. Sterile linen is placed around the area.
The procedure begins upon the insertion of the needle into the injection site. This is usually done under fluoroscopic (X-ray) guidance, although other guidance techniques can also be used. The three most commonly used approaches are the caudal, transforaminal and laminar approach.
The caudal approach inserts the needle from the area near the sacrum (tailbone), and has been reported to give up to 75% of patients relief of symptoms.
The transforaminal approach injects the steroid into the opening of the spine (foramen) of the spinal canal, and is preferred because of shorted operating time and lower radiation exposure.
The interlaminar approach is chosen when the other techniques cannot be used, and has been shown to provide comparable outcomes in relief of pain and other symptoms.
As with any invasive procedure, epidural steroid injections are not without risks. While the outcomes are generally positive, there is a risk of infection at the surgical site, intraoperative damage to the muscles, nerves and surrounding tissues, as well as the risk of bleeding and hematoma formation.
Premier Pain & Spine in Chicago has seven locations providing top notch medical and interventional pain management. The Chicago pain management doctors are Double Board Certified and experts in all three types of epidural steroid injections. Success rates are very impressive and most patients are able to avoid surgery as well.
Most insurance is accepted at the Chicago pain clinics, call Premier Pain & Spine today at (847) 519 4701 to schedule with a location close to you!
Botwin, KP et al. Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehab. Dec 2002, Vol 81(12), pp. 898-905.
Kim HJ, Rim BC, Lim JW, et al. Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc. Ann Rehabil Med. 2013 Dec;37(6):824-31. doi: 10.5535/arm.2013.37.6.824.