Epideral Steroid Injection
Dr. Chakerian has recommended that you receive an epidural steroid injection for the treatment of your pain. The location of the injection may be cervical (neck), thoracic (mid-back), lumbar (lower back), or caudal (tail bone). A cortisone-type medicine (“steroid”) and a local anesthetic are injected into the epidural space surrounding the spinal nerves. The medicine bathes the nerves in this area and begins to interrupt the pain-spasm-pain cycle, ultimately giving you pain relief. It is hoped that this will allow you to start a program of gentle exercise, relaxation, and rehabilitation. The steroid medicine has anti-inflammatory properties which will reduce swelling and pain, thereby allowing the healing and recovery process to begin.
Upon arrival at the surgery center, a nurse will escort you to a room where you will change into a gown before entering the procedure room. This is a special room, kept to the highest standards of cleanliness. To reduce the risk of ‘outside germs’, we request that only our pain center staff accompany you there. An intravenous line (IV) will be started prior to the procedure, and you will be placed on a monitor that will check your blood pressure and heart rate. The IV provides an easy route by which you will receive medication to help you relax and make the procedure as comfortable as possible. You will not be ‘put to sleep’, and you will be able to respond and move if the doctor or nurse asks you to. The actual injection only takes a few minutes. It is rare for any of my patients to experience significant pain during the procedure, and every effort is made to ensure your comfort.
You will need to stay approximately 30 minutes in the recovery room following the procedure. The medication you received to help you relax will wear off very quickly. The total time you will be at the center is approximately 90 minutes. The nurse will tell you what to expect and how to take care of yourself after you return home. You will also receive these instructions in writing. For safety reasons, we request that you do not drive yourself home.
Post Procedure Symptoms
Pain Relief – It may take 2-3 days before the steroid medicine starts to work. It may take 3-10 days before the full benefits of the steroid medicine become apparent. During this time you may need to use your pain medicine. Remember the steroid medicine needs time to work. For optimum pain relief epidural steroid injections are usually performed in a series of three, but your doctor may modify the treatments to best suit your needs.
Local tenderness at the injection site – This is normal and will pass within a few days. You may use cool packs to the area to relieve discomfort, and/or your pain medicine. If you use a cool pack be sure that the numbness from the local anesthetic used at the injection site has resolved. If there is redness, swelling or bleeding at the injection site and/or fever, please report this to the doctor.
Facial flushing – this is a side effect of the steroid and will pass within a few days. This rarely accompanies a fever. Check your temperature. If it is above 101 please report this to the doctor.
Acne – Occasionally acne may temporarily worsen for a few days. This is a side effect of the steroid.
Indigestion – This is a side effect of the steroid and may last a few days. Try to eat small, frequent meals. Avoid highly spiced, rich foods during this time. Over the counter antacid medicines (Zantac, Pepcid AC, etc...) often relieve this symptom. Occasionally nausea may occur on the day of the procedure. Make sure to follow the post procedure instructions given to you by the nurse. If nausea, vomiting, or indigestion becomes persistent, please call the doctor.
Headache – This may occur on the day of the procedure and last a few days. If the headache becomes severe, please call the doctor. It is very helpful to the doctor or nurse if you check your temperature before you call.
Insomnia – This is a side effect of the steroid and may last a few nights. A warm beverage and a simple relaxation exercise (i.e. listening to music) can help aid you in getting a restful nights sleep.
Useful information to report to the doctor at your next visit
- How much of the pain was relieved after the injection?
- How long did your pain relief last?
- Was there any change in the type of pain you experience?
(e.g. Shooting? Aching? Burning?)
- Has your ability to perform activities improved?
- Did you experience any side effects?
Be sure to take your medicine(s) as the doctor orders, especially if there are any new medicines prescribed on the day of the procedure.
The nurse will attempt to contact you by phone a few days after your procedure to ask you how you are doing.