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How epiduralsteroid injectionscan help get yourback painunder control

By: [Mark Moran, MD, MS]Lets face the facts: Each of us will most likely be affected by backpain at some time. Actually, eight of 10 people will be affectedat one point in their life. Furthermore, about 50 percent of theworking force will miss work due to back pain each year.Clearly, the deck is stacked against us. However, many medicaltreatments are available. One of the first–line interventional therapiesavailable is the back steroid injection, or epidural steroid injection.If you have chronic back pain, you have probably heard of epiduralsteroid injections.

Epidural steroid injections are used for pain throughout the back andneck, arms and legs. Most of the time a patient will visit with a doctorfirst to be examined and to discuss options for pain management. Ifthe doctor and patient agree to proceed with injection, the patientwill be taken to the procedure room. After the skin is numbed, thedoctor will use real time x–ray images to guide the advancement of theneedle. Once the desired location of the needle is verified, the steroid isinjected. The entire procedure takes minutes. Afterword, the patient ismonitored for 15–30 minutes to in the recovery room.A very common question is when will the steroid start to have anaffect. This is very individualized but most patients will start to notice abenefit slowly accumulating over the next two to three days. In somecases, it can take the steroid seven to 10 days to have an affect. Somepatients will need a second or third injection before noticing a benefit.Another question concerns how many steroid injections a patient canhave. Once again, each patient will have an individual medical situation,but a rough guideline is three steroid injections in a 6–8 month period.Too many steroids can cause medical concerns including high bloodpressure, hormonal fluctuations, weakening of the bones, blood sugarfluctuations, and fluid retention to name a few. This is why we try to limitthe number of injections to three per 9–12 months.

A final question most patients want to know involves length ofbenefit. How long will it last? The most accurate answer is we simplydon’t know. Many factors go into determining efficacy and durationof benefit including technique, amount of steroid injected, individualmetabolism, level of disease, and most importantly, the patients’perception and tolerance of pain. Another important factor to consideris the cause of the pain. Many different things can cause back pain, someof which are much more responsive to steroid injections than others.Many patients can have over a year of benefit after one injection whileother will not get any benefit from three injections. The best thing to dois talk with your pain doctor to discuss your risk factors and prognosisfor expected length of benefit.

If you have back pain that has been present for more than threemonths without improving symptoms, this is chronic pain. Manyoptions are available to treat the pain from conservative measuresincluding physical therapy and chiropractors, to medication treatmentand interventions. If you have tried conservative measures or have notobtained the desired benefit, consider talking to a physician specializingin chronic pain management.

After a complete review of your situation and physical exam, youmay find an epidural steroid injection is the treatment that will finallyprovide some relief and maximize your pain control.

Dr. Mark A. Moran is a diplomat of the American Board of Anesthesiology.With training focused on a multidisciplinary approach to pain relief, hestrongly believes in using physical therapy, exercise, and total healthmaintenance to help patients minimize pain by maximizing health. Hisoffices are located in the Medical Center, Boerne, Stone Oak, and Alamo