Epidural for Back Pain
My husband has debilitating lower back pain. It took him a while to get a diagnosis – as we all know, insurance requires our physicians to jump through hoops to order diagnostic tests. Eventually, he had an MRI that confirmed a herniation in a vertebra at the lumbar level, and he was quickly referred to a neurosurgeon. It was bad enough where an easy surgery wasn’t indicated, but not bad enough that he couldn’t put the surgery off until he was ready. He needed to have a fusion of the spine to fix it, but he could deal with the pain until he couldn’t anymore, because as we learned, one fusion surgery inevitably leads to another, especially when you are dealing with the lower spine. So, what about an epidural for back pain?
This was actually offered. The injections did manage his pain temporarily. He would get the injections every several months and feel pretty dang good. However, he also noticed that his legs were weak when he got the injections, which is not a good feeling for a 30-something guy who is active in running, skiing, snowboarding and softball. So, he looked for answers.
What to Know about Epidurals
Before we look at the pros and cons of an epidural for back pain, let's clearly explain what it is and what to expect for the procedure.
First off, before the actual epidural is applied, you will receive a local anesthetic so pain isn't an issue. The epidural itself contains a steroid that is used to help spinal stenosis and herniated disks.
The procedure isn't painful but you may feel pressure at the injection site. The doctor will also tell you not to move, as the needle must stay steady and precise. Once the injection is complete, you will be required to stay for monitoring for 15 to 20 minutes. Then, you can go home.
Unfortunately, they work differently for case by case, and they can last anywhere from one week to a year.
Side Effects
Like any treatment or medication, side effects can arise. Your doctor should review these with you before you agree to the procedure:
- Steroid flush (increased body temperature for a few days).
- Sleeping problems and changes.
- Anxiety and nervousness.
- Menstrual and cycle changes.
- Water retention.
- Increase in back pain (this is rare).
The Pros
As my husband found out, the injections can be highly effective at reducing pain. They helped him live a more normal life until the next injection.
The injections are given by a highly trained physician, typically a radiologist. It is typically cortisone, a steroid that is known to reduce inflammation.
Although some institutions have specific rules for how many injections can be given per the calendar year (or at all), research indicates that there is no upper limit to this number.
There are also other types of injections that can be given to reduce pain, such as trigger point injections and facet injections.
These injections may use just a local anesthetic or a local anesthetic in conjunction with a steroid. They may be equally effective if used with a steroid, but likely won’t work for a long duration if used just as a local anesthetic.
Some people like injections for pain control because it means a reduction in taking oral pain medication, which can have a laundry list of side effects, especially if they have other comorbid conditions, such as liver or kidney conditions.
The Cons
Cortisone may reduce inflammation. However, it is so potent that it can weaken tendons and break down and soften cartilage.
What does this mean for the long-term? This may not be a big deal for people who are not surgical candidates, but for someone, like my husband, it may mean that his musculature, his cartilage and tendons may be too weak to hold up after the surgery, rendering the surgery ineffective.
It is also a widely known fact that steroids can increase blood sugar levels. For some people with diabetes, an injection of cortisone does not increase blood sugar levels or only does so temporarily and for others, the cortisone injection wreaks havoc on blood sugar levels for days and even weeks afterward.
The Bottom Line
There is no right or wrong answer as to if you should get spinal injections for back pain. They are highly effective and can be an excellent way to treat pain.
Always weigh the pros and cons and your goals for further surgical options.