Steroids for Back Pain

Epidural injections provide pain relief in severe cases of lower lumbar and sciatic problems. Though this is a common treatment for extreme cases, it must not be administered when pregnant or when the patient has a local infection or in bleeding cases such as hemophilia.

ESIs

• An epidural steroid injection (ESI) is a common treatment for many kinds of lower back and leg pain. ESIs have been in use since 1952 and still constitute an integral part of non-surgical treatments for sciatica and lower back pain. This injection is a pain-relief measure, and though it alone provides sufficient relief, an epidural steroid injection is used in combination with other rehab programs to offer added benefits.

Benefits of an Epidural Steroid Injection

• Epidural steroid injections are used to carry the medication directly or close to the source of pain, as opposed to oral steroids and painkillers, which possess a discrete, lesser-focused impact and could also produce undesirable side effects. Also, because most pain is produced by chemical inflammations, an epidural steroid helps manage the local inflammation and also "flushes out" the inflammation-causing chemicals and proteins within the local area that cause and worsen the pain.

Composition of Epidural

• Typically, an epidural consists of cortisone-steroid coupled with a local anesthetic such as lidocaine or bupivacaine and/or saline.

  A steroid, or cortisone, is used as an anti-inflammatory agent to reduce pain and swelling. Commonly used steroids are methylprednisolone, triamcinolone acetonide and dexamethasone.

  Lidocaine, also known as xylocaine, is used as a local anesthetic for temporary pain relief. A longer-lasting medication such as bupivacaine could also be used. These local anesthetics basically are used for relieving the pain and also act as "flushing" agents that can dilute the chemical that cause and promote inflammation.

  Saline too is used to dilute the local anesthetic or act as a "flushing" agent

Indications for Lumbar Epidural Injections

• Several conditions that cause acute and chronic lower back pain and leg pain called sciatica can be treated by epidural steroids. The most common conditions are:
  A herniated lumbar disc, caused when the nucleus of a disc forces through the outer ring into the spinal canal where it causes pressure on the nerves and the spinal cord.
  A degenerative disc, where a collapse of the disc space might impose onto nerves of the lower back.
  A lumbar spinal stenosis, caused when the spinal canal chokes the nerves and the spinal cord, causing major pain.
  A compression fracture in a vertebra.
  Cysts of the facet joint or the nerve root that can expand and squeeze the spinal structures.

When to Avoid an Epidural

• An epidural needs to be avoided in the following conditions:
  Presence of a local or systematic infection.
  Pregnancy--when using a fluoroscopy or X-ray.
  Bleeding problems, such as patients using blood thinners or those with hemophilia.

Success and Risks of Epidural Steroid

• Although the effects of the injection are temporary, patients experiencing low back pain get quick relief. Also, more than 80 percent of patients suffering from a herniated disc experience relief, and 75 percent of the lumbar spinal stenosis problems find respite from the pain. A vast majority also have an increased duration in walking and tolerance for standing for a long periods.