Treating Pain Blog

Pain Management

Benefits of epidural steroid injections for back and leg pain

Back and leg pain - National Spine & Pain Centers

Epidural steroid injections can help you conquer your back and leg pain and return to an active lifestyle.  Epidural steroid injections are also known as ESIs, spinal injections, or epidural injections.  They relieve back and leg pain due to an injured disc that pushes on the spine or on the spinal nerves.  Epidural steroid injections are conservative (non-surgical) treatments, often used alongside medications and physical therapy.

Epidural steroid injections (ESIs) are treatments offered by a pain doctor and performed in a pain clinic.  You go home the same day.  During an ESI, the doctor places pain-relief medicine in your epidural space, near the spinal cord.  This allows the medicine to reach the painful areas in your back, such as the spinal nerves.  An ESI can offer you weeks to months of pain relief.

What causes back and leg pain?

There are many causes for your back and leg pain.  A common cause is an injury to a disc.  The problem starts when a disc (the gel-like cushion between your backbones) shifts out of place leading to a “disc bulge” or a “herniated disc”.  When a disc presses on a large spinal nerve, the injured nerve becomes inflamed and causes pain.

Your disc injury may feel like “back pain” and the nerve injury as “shock-like pain” that travels to the buttock, legs or feet.  Back pain and pain that travels to the leg(s) may start at the same time or separately.

Here is some more information on herniated discs.

What kind of pain does an ESI treat?

Several other common problems can cause inflammation that results in back and leg pain.  These problems can lead to short-term or long-lasting pain.

ESIs help decrease pain due to:

  • Herniated discs
  • Disc bulges
  • Degenerative disc disease
  • Nerve root pain
  • Sciatica

Some common causes for back and leg pain are explained in more detail here:

  • Herniated disc  –  the gel-like center of the disc bulges or breaks through a weak area in the disc wall.  The gel-like material comes in contact with your spinal nerve causing swelling and pain.
  • Disc bulge  –  the vertebrae (back bones) put pressure on a disc, causing it to bulge into the spinal canal where it presses on the spinal nerves, causing pain.  Disc bulges can start early (30-40 years of age) and often heal naturally, such that you rarely feel anything.  However, in time, they can lead to pain.
  • Degenerative disc disease  –  breakdown or aging of the discs causes tears in the outer disc layer, the collapse of the disc space, and abnormal bone growths around the disc (bone spurs).  These can all put pressure on your spinal nerves.
  • Nerve root pain  –  pain caused by pressure on the nerve as it branches out from the spinal cord. This can cause pain in your lower back, buttocks, thighs, calves, feet, or toes.
  • Sciatica  –  inflammation of the longest nerve in your body, the sciatic nerve.  Shock-like pain and numbness runs into the buttocks and down the back of the leg, all the way to the foot or toes.

What medicine is in an ESI?

The main medication in an ESI is the steroid.  Different steroids can be used –  they prevent inflammation and allow your body to heal.  This may calm your pain for months at a time.

Another medication is sometimes added to the ESI: a local anesthetic.  This medicine decreases pain fast (within minutes) by blocking pain signals in the nerves.  Local anesthetics relieve pain for several hours.  They help bridge the time gap that it takes for the steroid (a slower acting medicine) to start working.

When should I get an ESI?

  • ESIs are used for pain in patients with disorders involving the nerves and bones of the back.  An ESI works alongside other methods like medications.
  • ESIs can be useful during physical therapy.  When pain hinders your physical therapy, an ESI can control the pain so you can complete your rehabilitation.
  • ESIs are an early treatment, used to control pain before surgery is necessary.

How can an ESI help me?

  • ESIs decrease pain in the low back (or neck – depending on the level of the spine where your doctor places the medicine)
  • No drowsiness – unlike some pain medications, there is no drowsiness after an ESI
  • Based on a patient’s response after an ESI, a doctor can decide where a back surgery needs to be done in the future
  • An ESI is a minimally invasive procedure; there are no scars -there is only a small entry site where the needle is placed past your skin

For a patient success story, after treatment at NSPC, click here.

How is an ESI done?

  1. An ESI is done in a pain doctor’s office – it takes only a couple of minutes
  2. You are prepared by an intake team and are placed, face down, on a procedure table
  3. Your back is washed with a sterile (liquid) solution, in order to prevent infection
  4. X-rays are used to place the medication precisely at the source of pain and to maintain safety standards
  5. After the procedure, you have a short recovery period and then go home

How many injections can I have?

A series of ESIs can be more effective.  Pain doctors often perform a series of three ESIs, several weeks apart, over the course of six months.

How long before an ESI starts to work?

ESIs contain a steroid and sometimes a local anesthetic, a nerve-numbing medicine.  The steroid starts to work within 24-48 hours. Patients that respond well to an ESI, usually have pain relief after two days.

The local anesthetic starts to work right away by stopping pain signals in the nerves.  However, its effects last only for a couple of hours and therefore offers short-term pain relief.  The steroid is the long-acting medication that can offer you weeks to months of pain relief.

What can I expect after an ESI?

Epidural steroid injections do not change the wear and tear in your spine.  However, they decrease swelling in the area of pain, such as the herniated disc.  The body slowly absorbs the disc fragments, as it heals.  Thus, the steroid helps relieve your pain.

Some patients don’t benefit from ESIs.  In later stages of back pain, there may be several causes for pain, other than inflammation, and steroids may not help.  If an ESI does not offer you relief, your pain doctor will discuss other treatment options that can help you.

Back pain treatments offered at NSPC

Our pain doctors follow a stepwise approach when evaluating your pain.  They conduct an in-depth medical exam, a complete history of your pain symptoms, and they perform advanced diagnostic tests. Click here for an appointment with one of our pain physicians to see if an epidural steroid injection can stop your pain and help you get back to a more active lifestyle.