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Pain Management 101: Epidural Steroid Injections

Question: I am having an epidural steroid injection for my low back pain. I am just wonderingdoes the injection hurt, and will it actually reduce my pain? Will I need to have multiple injections?
—Vancouver, BC

Answer: These are all great questions to ask because they show that you're taking an active role in your treatment plan for your low back pain.

Let's first address that big question that worries many people going in for an epidural steroid injection: Will it hurt? The answer is both yes and no. If you have an injection into an area that's already inflamed, you may have pain because that area is more sensitive. However, before getting an injection, you'll most likely have an anesthetic such as Lidocaine. The anesthetic will numb the area where you're going to have the steroid injection, so the actual injection shouldn't hurt as much. Additionally, your doctor can sedate you before he performs the procedure.

Depending on what's causing your low back pain, the epidural steroid injection should work. For example, it's been shown that injections work very well for herniated discs. That's when the center part of your intervertebral disc—which is the shock-absorbing part of your spine—pushes out through the rest of the disc. A herniated disc can press on your nerves, causing inflammation and pain. An epidural steroid injection should help reduce the inflammation and therefore, the pain.

If it's spinal stenosis causing your low back pain, an epidural steroid injection might not be as helpful in reducing your pain. I've noticed that patients with bony spinal stenosis (for example, when a bone spur is compressing the nerves and causing pain) don't find as much relief from epidural steroid injections. Patients with pain caused by a degenerative or arthritic spine condition can still have injections, but they need to be aware that it might not be as helpful as they wish.

Now for your final question: Will you need to have multiple epidural steroid injections? I have found that patients do generally require more than one injection, so I generally administer a short series. Your doctor will decide how many injections are best for you, and he will carefully monitor how your pain responds to the injection. He should follow-up with you 10-14 days after each injection.

I would like to add that the goal of an epidural steroid injection isn't to completely obliterate your pain. In fact, injections should be used in conjunction with a physical therapy exercise program. The injection will take care of the pain and inflammation so that you're able to participate in the active exercise portion of your recovery. You will probably have an exercise program that increases your muscle flexibility and strength, in addition to helping you get back to functioning normally.

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