Epidural Injections to Reduce Pain from Pinched Nerves

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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.
Pinched nerve color illustrationCommon 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.

Updated on: 08/21/18
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Todd J. Albert, MD
Epidurals, and more particularly selective nerve root blocks, have been extremely helpful in our practice. Of note, people on blood thinners such as Coumadin need to be off of these prior to a spinal injection and have a PT/PTT (prothrombin time/partial thromboplastin time) check prior to having a needle placed into the epidural space. Also, diabetics should be counseled to watch their blood sugar carefully up to 24 hours after the injection, as steroid medication can increase their blood sugar.
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