Back Pain Specialist Explains: Epidural for Back Pain [Pros and Cons]

Epidural injections for back pain relief are increasingly becoming more popular.

In a 2015 study involving 120 participants with low back pain who received four epidural steroid injections in a year, researchers found that more than 50% experienced pain relief and functional status improvements.

As a back pain relief, the injection transports the steroid medication (also known as cortisone) to the inflamed nerve roots within the epidural space (the fat-filled area between the bone and protective sac of the nerves).

The anesthetics stop the pain-spasm-pain cycle, while the steroid reduces the irritation in the treatment area.

While epidurals can tone down the symptoms of chronic back pain, the underlying causes may still linger in the body. Like similar spinal injections, getting an epidural injection for pain management has benefits and risks.

Our resident vascular specialists here at VISP will weigh them for you. Continue reading to learn more about the pros and cons of epidural steroid injections.

How Epidural Steroid Injections as Back Pain Relief Work

For people suffering from chronic low back pain, receiving an epidural steroid injection can significantly provide immediate pain relief and improve body functions. 

Doctors typically recommend this procedure, in conjunction with physical therapy, to alleviate pain from:

• Herniated discs that damage and press nerves causing pain
• Spinal stenosis or the narrowing of the spinal canal
• Failed back surgery syndrome (post-operative chronic back or leg pain)
• Bone spurs due to joint damage associated with osteoarthritis
• Other injuries to spinal nerves, vertebral column, and surrounding tissues

Epidural steroid injections involve injecting steroids and anesthetics into the inflamed nerve roots within the epidural space.

The steroid reduces inflammation in the area with back pain while the anesthetics interrupt the pain-spasm cycle. The combination of the two helps with the pain management abilities of other areas of the spine.

One to two injections with 1-4 week intervals can give a satisfactory effect to patients with mild low back pain. Meanwhile, those with chronic conditions can get the injections at 3-6 months intervals. 

The length of pain relief varies, lasting for weeks or years. It’s ideal to receive epidural injections together with exercise programs such as physical therapy to reinforce back muscles and prevent future inflammation.

Epidural For Back Pain (Pros and Cons)

Now, let’s dive into the benefits and drawbacks of epidural steroid injections. 

Pros

The benefits of epidural steroid injections include:

• Epidural injections are generally noninvasive and safe especially when performed by an experienced and skilled medical practitioner
• Patients can return to their normal daily routine the next day after the procedure
• Low risk with minimal side effects
• Receiving epidural injections allow you to postpone or eliminate the need for a surgical procedure, especially if you combine the medication with physical therapy
• The injection can be used to relieve back pain, as well as pain in the neck and leg.
• Epidural injections have a high success rate. The effects can last for several days or years. 
• The injection improves the quality of life of patients suffering from mild to excruciating back pain. It relieves pain and allows the individual to get back to their regular activities the next day.

Who’s a candidate?

Aside from back pain, an epidural injection also benefits those with neck, arm, and leg pain (sciatica). 

Specifically, those with the following conditions:

• Spinal stenosis
• Herniated discs
• Spondylolisthesis (nerve root pain due to weakness between the upper and lower facets of a vertebra)
• Degenerative disc associated with aging
• Sciatica (pain that occurs when there’s a pinched or compressed nerve root in the lower back, which radiates down to the buttock, thigh, legs, or foot)

Cons

Epidural Steroid Injections may bring a patient these drawbacks:

• Risky if done by an inexperienced doctor. A misplaced needle can irritate the already inflamed spinal nerves further.
• The medication can infect the brain, spinal cord, or other areas near the injection site.
• If not administered properly, an epidural steroid injection can damage the arteries and cause bleeding within the soft tissues, epidural space, and spinal membranes. The condition may lead to a blood clot.
• Some patients may experience low blood pressure and heart rate.
• Prolonged treatment might lead to a higher risk of osteoporosis (weak bones).
• Can be costly considering the short-term pain relief it provides.
• Facial flushing in rare cases.
• The steroids may lump together and build up in the blood vessels which may lead to poor blood flow in the spinal cord. The condition is more likely to occur in patients with allergic reactions to steroids or local anesthetic, and those who are over 50 years old.
• Other possible side effects: bleeding, nerve damage, ulcers, dural puncture, high blood sugar levels, or cataracts.

Who Should Avoid Epidural Injections?

Like other medical procedures, steroid injections may not be suitable as a chronic back pain relief to people with certain health conditions. Make sure to consult your doctor first if you have any of these issues:

• Infection
• Bleeding issues
• Diabetes
• Glaucoma
• Pregnancy

FAQs About Getting an Epidural Steroid Injection

What are the risks of getting an epidural for back pain?

An epidural steroid injection procedure is associated with the following risks:

• Bleeding
• Nerve damage
• Stomach ulcers
• Dural puncture
• High blood sugar levels
• Cataracts
• Osteoporosis

What are the long-term side effects of epidural steroid injections?

Among the risks of epidural steroid injections, these are the long term side effects that you should be careful of:

• Infection
• Bleeding
• Endocrine effects
• Neurotoxicity
• Neurologic injury

Do epidurals weaken your back?

Epidural steroid injections are anti-inflammatory medical drugs that are usually limited to just a few a year. Steroids can weaken your spinal bones and nearby muscles if not taken according to their recommended dosage. 

How Long Do Epidural Injections Last For Back Pain?

Depending on the patient’s condition, epidurals can relieve pain for several days or years. Epidural injections are done together with physical therapy and/or other exercise programs to reinforce back muscles and prevent future inflammation.

What are other nonsurgical alternatives for back pain relief?

Although magic pills don’t exist, back pain shouldn’t be a thing that you just have to live with. There are many other minimally invasive choices to help you feel healthier and significantly improve your quality of life.

According to Dr. David Lloyd, neuroradiologist with Dignity Health, Yavapai Regional Medical Center and Vascular and Interventional Specialists of Prescott, vertebroplasty is a highly effective and noninvasive back pain relief alternative to epidurals. 

Vertebroplasty is commonly recommended for compression fractures of the spine, which are most often found in osteoporosis patients. A cement-like material is injected into the broken bone to stabilize the fracture. Most patients experience pain relief and the renewed ability to go back to their daily activities almost immediately.

How To Prevent the Side Effects of Epidural Injections?

Generally, epidural steroid injections are safe for pain management. Talk to a doctor to make sure that you don’t have any underlying conditions that may be at risk with steroids and needles. 

Additionally, consult with a trusted and highly experienced doctor. Find qualified physicians such as physiatrists (PM&R), radiologists, anesthesiologists, neurologists, and surgeons.

If you need a medical consultation for your body pain problems, VISP – Vascular and Interventional Specialists of Prescott is here to help you.

Our expert radiologists can administer you with epidural steroid injection and prescribe you other pain relief methods according to your condition!

Visit our website to know more about our services, or call us at 928.771.8477 to book an appointment today.