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Nearly everyone experiences an episode of low back pain at one time or another during his or her lifetime. Often low back pain results from nerve compression. Typically, the patient's complaint includes a low backache or
sharp pain traveling down one or both legs.
Common causes of pinched nerves
include disc protrusions into the nerve space, arthritic facet
joints with resultant narrowing of the spinal canal, and bone
spurs. Less often, scar tissue that has formed from a previous
surgery can cause nerve impingement and pain.
Nerves exit the spinal cord through
the epidural space. Often, this space is utilized to deliver
medicine in close proximity to the spinal nerves. The most effective
medications include local anesthetics (numbing/deadens pain)
and anti-inflammatory steroids, which help reduce swelling and
inflammation that can lead to pinched nerves.
The Classic Epidural Injection
The epidural space is often accessed
using a special type of injection. First, a sterile solution
is applied to the target site. Next the site is numbed with a
small injection of a local anesthetic. A special type of needle
is used to identify the epidural space.
Specialists in pain management
can offer techniques to overcome the deficiencies of this technique.
Unfortunately, many patients do not experience complete relief
of their pain. When complete pain relief is not achieved, the
pain management specialist may carefully question the patient,
utilize directed exam techniques, and radiographic studies to
help guide more specific injections.
Epidural Injection Needle
Guidance
A technique utilizing fluoroscopy
is often used to guide the needle. The practitioner is able to
watch the needle as it moves through tissues to its destination.
Fluoroscopy makes it possible to place the medicine close to
the exact lesion location (pinched nerve). In addition, modifications,
such as a flexible guided catheter can be maneuvered into the
proper position to deliver medication. Other modifications include
injecting into the foramen, the spinal windows where the nerves
exit.
The advent of new injectable
medications such as Clonidine, a drug originally used for high
blood pressure, and Wydnase, a protein which can dissolve scar
tissue, have allowed epidural procedures to be at the forefront
of modern pain management programs.
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