7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Epidural Steroid Injections

 

What it is used to treat?

 

Epidural injections are used in the treatment of pain in the neck, back and lower back  and for pain that radiates into the  buttocks, legs, arms, ribs or chest wall and head.

 

What the goal/purpose?

 

The goal of the epidural steroid injections is twofold.  One objective is to decrease inflammation around the nerve roots and adjacent anatomic structures.  The second and possibly more important objective is to physically separate the nerve from adhesions along the adjacent structures- in other words freeing up the nerve. Breaking up adhesions and freeing up the nerves can prevent symptoms from returning even after the effects of the medicine have worn off.

 

What should I do to get ready for the procedure?

 

Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol.   Read the list of medications that must be stopped that was given to you at your office visit. (This should link to list of meds that have to be stopped)  Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke.  It is your responsibility to clear this with your doctor. (This should link to the list of medications to stop)

 

Continue to take your other medications.  Do not stop blood pressure or diabetes medicines.

 

Do not eat or drink anything on the morning of your procedure. (This should link to page on pre-procedure instructions) You may eat and drink afterward.

 

How is it done?

 

Patients lay face down on the procedure table.  Monitors are attached to keep track of your vital signs during the procedure.  The area over the procedure site is prepped and draped in a sterile manner to protect against infection.  A fluoroscopic x-ray is then used to locate the target site.  The skin is numbed with lidocaine and a needle is advanced toward the target under x-ray guidance.

 

Once the needle is properly placed the radiocontrast is injected to make sure we are in the right tissue plane.  When we are sure we are in the right place the ropivacaine and steroid are injected.  The needle is removed. You are then taken to a recovery area for observation before going home.

 

There are different approaches to performing this type of procedure and different ideas about what is being done.  We use a relatively high volume transforaminal or catheter based approach.  For most people, this will lead to relief that lasts longer than a low volume steroid only approach.  Combining the epidural steroids with home neural flossing exercises greatly increases the chances of a good long term outcome.

 

What is injected?

 

Lidocaine to numb the skin.

Radiocontrast to make sure the medicine is going where we want it Ropivacaine (another local anesthetic) and a steroid (such as dexamethasone) In some instances hypertonic saline solution or hyluronidase enzyme are injected In the cervical and thoracic regions sterile saline is used to help position the needle appropriately

 

Will it hurt?

 

Most people tolerate these procedures very well.  There is some discomfort associated with numbing the skin and there may be pressure during the injection.  Some patients require some sedation for the procedure, and others do not. The vast majority of patients tell us ‘that wasn’t so bad” or “I can’t believe I was worried about that;” however some people do find it painful and may require sedation.

 

Important Warning!

 

Your legs may be very weak for up to 24 hours after treatment.  Hold on tightly to a rail if you must go up or down stairs.  Be extremely careful getting up and down and in and out of your vehicle.  The weakness is due to the effect of the local anesthetic in the epidural space- it is normal and will wear off, but if you have any concerns, call us.  Do not drive the day of the procedure

 

What is the chance of success?

 

Approximately 80% of our patients get significant relief from this type of procedure.

 

How often can the procedure be repeated?

 

Our initial plan is to do 1-3 of these procedures approximately 1 month apart.  Each time we inject the medications, we hope to break up more of the adhesions.  In other words, the injections build on each other, having a cumulative effect.  Also, by doing the home exercises you will be opening up the space more so that the medication spreads better at each subsequent treatment.  Most people over 40 will end up taking all three injections.  If you have one procedure and your pain is gone then we do not need to continue with the second procedure.  If you are not making some progress after 2 procedures we may not continue.  Some people will end up doing 4 procedures, instead of just three.

 

After the initial series you may need a booster or touch-up injection later.  We want to limit the procedures in one region of the spine to no more than 4-5 per 12-month period.

 

What can I do to maximize my chance of success?

 

Be consistent in your home stretching exercises.  Be careful not to reinjure your spine.  Remember that even though you are feeling better, you have to protect your gains and be conscious of how you move.  Do not go on a long trip right after an injection.  Do not do all the things you have been putting off.  Give yourself time to heal and get stronger.

 

Why do I have a blue towel in my pants/shirt?

 

We place a sterile towel over the injections sites to absorb any mild bleeding and protect your cloths.

 

Why are there EKG pads still in place?

 

If you have thin skin or hair in the area, we may leave the EKG pads in place so that you can gently remove them with soap and water at home.

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