Epidemiology of back pain
In US, approximately 60% to 80% of the population will experience mild back pain at some point in our lives. In 2007 alone, about 27 million US adults aged 18 or older (11% of the total adult population) reported having back pain, according to the Agency for Healthcare Research and Quality. Of the 27 million people, about 19.1 million people sought treatment by a doctor.
Causes of back pain
The human back is formed by a complex internetwork of nerves, tendons, ligaments, muscles discs and bone structures. At times, the system can develop problems from poor posture, medical conditions, repetitive movements, injury and others. Muscles and ligaments can be strained leading to muscle spasms and tension. There may be damaged discs, disc degeneration, disc herniation, arthritis, synovial cyst (sterile sac of fluid) of the facet joints (joints of the spine), tarlov cysts (sterile sac of fluid found attached to the nerve), fractured or broken bone or disc, slipping of back bone called spondylolisthesis among other causes. Essentially the nerves in the region are inflamed leading to the symptoms.
How does an epidural work?
People generally refer to the symptoms arising from a disc related issue that radiate down the legs as sciatica. Those shooting or symptoms that go down the arms or legs are generally treated by a shot called an epidural. Epidural space is a potential space just outside the sac that contain the spinal cord composed of epidural fat, epidural veins, connective tissue and spinal nerve roots. The region is utilized as spinal nerve roots can be accessed through this space named epidural space.
The medications injected are usually a combination of local anesthetic (numbing medicine) and a steroid often referred to as cortisone. The injected medication combination decreases the inflammation and the irritation of those nerve roots allowing the body to heal. The local anesthetic provides immediate pain relief while the steroid effect will peak within the week providing more long-term relief. The break in the pain cycle, caused by chemical irritants released by the body, when the medications are injected also provides a longer lasting relief.
What can be expected on the day of the injection?
Epidurals are performed generally at a surgical center and at times in the office procedure suite for certain types of injections. Prior to the procedure, all blood thinners need to be stopped after discussing with the prescribing physician unless told otherwise by the physician. Similarly, on the day of the procedure, patients cannot eat by mouth and need an adult to drive the patient and to take care of him/her after the injection. The procedure is classically performed using an X-ray machine called c-arm or fluoroscopy. The needle is guided into the epidural space and is also confirmed by the properly trained physician’s hands as there is a distinct feel when the epidural space is entered. Unless the patient has an iodine allergy, an iodinated contrast is injected to confirm proper location and a lack of intravascular injection. Once that is confirmed, mixture of local anesthetic and steroid is injected.
What can be expected after the injection?
Epidurals and nerve blocks have been safely performed for decades. As with any procedures, there are always risks. Risks can be bleeding, headaches, tissue damage, nerve damage, allergic reaction, and infection. More serious events are very rare such as paralysis and other rare events. As you are aware, epidurals for pregnancy is performed daily with minimal complications and pain procedures have additional safety of x-ray machine and contrast use. Epidurals and pain procedures have been safely performed under the hands of well trained and qualified physicians for decades.
More often than not, patients tolerate the procedure without any notable side effects. At times, there can be steroid induced effects such as flushing of the face and chest, anxiety, water retention, trouble sleeping and menstrual cycle changes that resolve within days without a need for further treatment. One may experience a temporary continuation or an increase in symptoms post procedure depending on the nerve irritation and severity of symptoms prior to treatment. Patients are asked to have a non-eventful day post procedure to recover from both the injection and anesthesia. Patients generally do well after the epidural resuming normal activities.
Although there are no guarantees, most patients tolerate the procedure well and are very happy with the results. The symptoms can last from months to years. If the treatment is successful, patients receive periodic procedures to maintain pain relief without a need for surgery preventing permanent anatomical changes and other potential consequences. Even after surgeries, certain types of epidurals can be performed with success as well as spinal cord stimulation. A complete treatment plan may include periodic or regular medications and adjunctive therapy in addition to other types of injections as our body is complex with interworking of many different parts.
Contact Houston Pain Specialists for a consultation today at 713-664-2662.