Injections Topics and Resources

Injections Topics and Resources Typically, most patients will be prescribed for some combination of physical therapy and medications, once they have been formally diagnosed. Following some combination of these two treatments, patients will experience a lasting recovery phase to their condition if and optimistic outcome prevails. In some cases, though, patients may be selected for steroid injections is one of these two circumstances occurs:
  • Patients do no experience back pain relief from any of these treatments.
  • Doctors prescribe steroid injections to give patients with enough short-term pain relief to continue their physical therapy program.
As suggested above, steroid injections are only a short-term treatment for back pain. They may be used as a type of palliative care for chronic pain conditions that have not responded well to any other form of treatment. Or steroid treatments may be used as a type of short-term treatment to but patients and their therapists with just enough time to finish their physical therapy protocols without giving up due to severe pain levels.

Regardless of what reason patients choose to receive epidural steroid injections, they do have their uses, as well as several side effects associated with long-term and repeated use. Here we will outline several important injection topics and resources. Lumbar Epidural Steroid Injections: The type of back pain that most commonly becomes a chronic and disabling problem is lower back (lumbar) back pain. The structures of the lower back are stronger and denser in composition to meet the demands of their position at the base of the spine, yet they do succumb to wear and tear over time. Because of their position, they bear the strongest forces of gravity, and are subject to higher pressures and stresses than at other levels of the spine. Hence, they may wear out quicker, accounting for many of the back pain cases doctors receive at their clinics. Epidural steroid injections (ESIs) may provide patients with significant relief from lower back pain and associated leg pain for up to several months.



ESIs are often classified as a non-surgical treatment for low back pain or sciatica, though many hospitals and clinics list any back treatment that involves the puncture of the skin to be a minimally invasive surgery. If this treatment is successful, it may provide relief lasting for up to 1 year. Patients may receive as many as three of these types of injections to the same area of the body in a single 1 year period. Most research studies indicate that over 50% of patients respond favorably to this type of treatment. Most of the respectable physicians and clinics insist that a proper injection procedure involves the use of Fluoroscopy to guide the needle into the proper position to find the correct injection site.

Clinical Benefits: Traditional pain medications are taken orally, where they are digested and absorbed into the bloodstream before they can have their intended effect. These medications, when taken this way, affect the entire body and often in negative ways. For example, when NSAIDs are taken regularly they often cause distress on organs throughout the digestive system as well as the kidneys. Epidural steroid injections involve the delivery of a much smaller amount of analgesic (pain-relieving ) medication to a much more specific site in the body. Epidural steroid injections involve the delivery of corticosteroid medication near the source of the pain generation. The combination of steroid medications and other fluids delivered in the injection may have the dual effects of inhibiting the inflammatory process around the area of trauma/injury, as well as "flushing out" inflammatory proteins and chemicals produced as byproducts of whatever injury that caused the pain. Other components of the injection fluid include saline and a local anesthetic.

The Epidural Space: The spinal cord is a continuation of the brain that travels through the spine within the vertebral arch. The spinal cord is composed of spinal nerves, which is surrounded by the dural sac. Located just outside the dural sac is a region known as the epidural space. This epidural space is filled with fat and small blood vessels. In order to relieve chronic pain, a needle injection of the ingredients as mentioned above may block inhibit inflammation and flush out toxic chemicals near the nerves that would have stimulated the transmission of pain signals to the brain.

The typical components of a steroid injection include a steroid (cortisone), local anesthetic (bupivacaine or lidocaine) and/or saline. Other commonly used corticosteroids include Methylprednisolone acetate, Dexamethasone, and Triamcinolone acetonide.

Sciatica Benefits: Many of the lumbar nerves, originate in the lower back, and transverse the hips buttocks, upper and lower legs. If the nerve becomes compressed near its point of origin in the spine or sacrum, and part of the anatomy supplied by that nerve may be effected. This is way compression of the sciatic nerve, one of the longest in the body, often causes both back and leg pain. The sciatic nerve may be affected with it is pressed upon by strained upper leg muscles, or when back conditions such as lumbar disc herniations or facet joint arthritis cause the release of chemicals that stimulate inflammatory processes around the sciatic nerve. Steroids released in the epidural space near the source of the back problem may inhibit the release of these chemicals.