When Does Back Pain Call for an Epidural Steroid Injection?

Back pain epidural steroid injectionAs a physiatrist at the Emory Orthopaedics & Spine Center, I diagnose and treat back pain non-operatively, and one of the questions I’m asked most often by patients is whether they’re candidates for an epidural steroid injection.

If you have spinal pain, whether in your neck or back, your doctor will ask you whether it’s axial pain or radicular pain. Axial pain does not radiate into the arms or legs—it’s localized in one area. Radicular pain does radiate into the arms or legs. Axial pain typically is treated conservatively, with pain medication and exercise, and does not benefit from an epidural injection. However, if you have radicular pain and conservative measures haven’t helped, you may be a candidate for an epidural steroid injection.

In most cases, radicular pain is caused by one of two conditions—a herniated disc or spinal stenosis. Herniation is when a piece of the disc becomes disclocated, or slips, and presses on a nerve. This is more common among middle-aged patients, and 80% of patients with a herniated disc will get better over time without intervention. Disc herniations shrink as the body naturally self-heals. However, an epidural steroid injection can ease the pain and make the healing process more comfortable.

Spinal stenosis usually is caused by the natural wear and tear on the spine that comes with aging. Most patients with stenosis are 65 or older. Stenosis is degenerative and can lead to spinal nerve root compression or bony stenosis, which can cause pain, numbness, and weakness. While spinal stenosis may eventually require surgery, an epidural steroid injection can be a good temporary measure if you’re not quite ready for surgery or are not a candidate.

At Emory, we used different injection techniques depending on the condition. An interlaminar epidural is similar to the epidural a pregnant woman may opt for before giving birth. In this case, the goal is to introduce the steroid around the nerve root to decrease inflammation, which, in turn, eases pain. A transforaminal epidural is a more selective injection in which we target a specific nerve root that may be compressed by a herniated disc or a bone spur. Your doctor will decide which technique will benefit you.

In most cases if you have back or neck pain, your first step should be to try conservative pain-relief measures. However, when pain medication and exercise don’t help, and you’re suffering from radiating pain, an epidural steroid injection may be a good solution. An Emory physiatrist can work with you to diagnose your pain and set you on the right course of treatment.

Have you had an epidural steroid injection for back pain? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below. If you’re interested in learning more, we have some great information on epidural steroid injections for back pain our website.

About Susan Dreyer, MD:

Dr. Dreyer is an Associate Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine.  Dr. Dreyer specializes in non-operative spine care and focuses on helping patients achieve their best functional level. She has taught many national and international courses on spine care and spinal injections for sciatica and other causes of back and neck problems.  She is also active in several professional societies. Dr. Dreyer started practicing at Emory in 1992.

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5 Responses to “When Does Back Pain Call for an Epidural Steroid Injection?”

  1. Mary says:

    I had 3 injections about 1 1/2 years ago. I had always heard what a traumatic experience this is. I felt NO discomfort or pain.

    Why all the fuss?

  2. Misbah says:

    I had two injections, three months apart. The first was successful after 4 days of increased pain. The injection lasted about three months. The second injection increased the pain level, and I did not feel any relief from the injection at all, only more increased pain in my arm and neck. Now I’m looking into surgery as my next and hopefully last option.

  3. Alicia says:

    Have had 4 injections and only the first one was successful. Trying to find a solution, if any, to pain from two bulging discs. Pain radiates to knee and is constant. Last injection increased the pain and have decided not to pursue any more injections. Planning on making an appt. to see a doctor at Emory.

  4. tracy says:

    hello,I am waiting for an epidural to decrease the pressure on the spinal canal due to two discs bulging, I also have two discs that have completely worn away and am in chronic pain. I will inform you of the outcome as soon as I have this as I will try anything and also answer any questions that anyone may have. If you have gone through this it would be nice to have your feedback. Trace xx