Tag Archives: spinal injection

What to Expect from an Epidural Steroid Injection

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When you have sciatica and a pinched nerve, or suffer from spinal stenosis, an epidural steroid injection may help substantially with your pain. First of all it is important to understand exactly why epidural steroid injections are performed.sciatica treatment

Predominantly, epidural steroid injections are performed to alleviate pain from a pinched nerve. When a nerve root is pinched, it becomes inflamed and generates pain along its distribution. That may be down the side of the thigh, or into the calf and foot.

Another indication for an epidural steroid injection may be if a person is having referred pain into the buttock area or hip region from either degenerative disc disease with a torn disc, or from spinal stenosis. An epidural injection is performed as an outpatient, and the injection takes about 20 minutes. Usually, IV sedation is not necessary as the person can receive numbing medicine injected underneath the skin and through the soft tissues providing satisfactory pain relief.

However, if a person has anxiety of claustrophobia, then IV sedation can be administered or an oral sedation pill to be taken 30 minutes prior to the procedure such as Valium.

With modern pain management, pain doctors use fluoroscopy to help with injection accuracy, which is a real time form of x-ray. Without fluoroscopy, research studies showed that about 30% of the time, the doctor will miss the correct spot for the injection.

There are three different kinds of epidural steroid injections, and the pain management doctor will pick the type that works best for the anatomy of the pinched nerve along with the injection that the doctor feels most comfortable performing.

When the injection is performed, the numbing medicine works within about a minute, and it may take the steroid a few days to actually begin working for pain relief. Steroid is a hefty anti-inflammatory andepidural steroid injection bathes the nerve roots with soothing anti-inflammation and can knock out the pain.

Once the numbing medicine wears off which is usually between six and 12 hours, a person’s pain may return for a bit. And then once the steroid begins working the pain will hopefully will be alleviated for a period of weeks to months. The timeframe for pain relief is extremely variable, and often times a full series of three injections is necessary to provide the best pain relief possible.

So if the pain relief wears off by the next day, do not fret considerably as it may just be a lag before the steroid starts to work properly. If a few months go by and the pain returns, the epidural steroid injections may be repeated. Pain doctors do not like to perform them too often as too much steroid injected can cause problems with blood sugars and one’s adrenal glands.

Most studies have shown epidural steroid injection to be at least 75% effective for spinal stenosis and relieving sciatica from disc herniations. They may prevent the need for risky spine surgery.

If you are experiencing sciatica pain or pain that radiates into your buttock and hip, an epidural steroid injection may help you substantially. Arizona Pain Specialists has double board certified pain management doctors in Arizona who have performed thousands of successful epidural steroid injections.

Arizona Pain has multiple locations around the Phoenix and Scottsdale metropolitan area serving Chandler, Gilbert, Mesa, Tempe, Ahwatukee, Surprise, Glendale, Avondale, Goodyear, Peoria and more.

Call 602-507-6550 for scheduling and more information the best Arizona pain center!

Is My Pain Coming From My Hip Joint Or A Problem In My Low Back?

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Pain that is in or around one’s hip joint may or may not be present secondary to a hip issue. The pain can also be coming from a low back spinal problem.

The potential generators of the pain can be:

1) Hip joint arthritis or a soft tissue problem inside the hip joint (labrum)

2) Intervertebral disc herniation

3) Spinal Stenosis

4) Soft tissue problem around the hip

5) Fracture in the spine

6) Hip Fracture

Hip arthritis pain or a labral tear may cause significant pain in the groin area on the affected side. Physical examination and x-rays will typically confirm the culprit as degenerative joint disease (DJD) in the hip. If the patient receives a hip injection as treatment and the pain is eliminated even for an hour, one can be certain the hip is in fact the problem with further treatments confined to the hip.

Groin pain can also be a result of a disc herniation. It’s not something typically seen in a textbook and it is an atypical presentation, but an L5-S1 disc herniation can in fact cause groin pain on the affected side. So if the exam and radiologic studies of the hip are not definitive for a hip problem, potentially obtain and MRI of the lumbar spine for the answer.

Pain that is around the hip joint may be coming from the spine. It is called radiating pain if it emanates from a spinal problem and then travels down into the buttock area or hip region. One such problem is called spinal stenosis, which represents nerve root compression at one or multiple levels from an arthritic process.

Spinal stenosis typically occurs in older individuals that may also be experiencing pain in the hip from arthritis. So the hip pain can be a combination of radiating pain from spinal stenosis along with the direct pain from the DJD in the hip. How is the diagnosis then made.

The combination of a good history, physical examination, and imaging studies often elucidates the source of the pain. If there’s still a question mark, injections can give the answer. Here’s an example. Betty is 74 years old and experiences pain on the outside and front of her right hip area on a daily basis. Activity makes it worse, and at times it wakes her up at night. Also it radiates down the front of her thigh a bit.

She is convinced the pain is coming from her hip since she has no back pain at all. On physical examination while moving her right hip all over the place, however, she has minimal provocation of her pain. X-rays show moderate arthritis in her right hip, with the same degenerative joint disease existing on her left side as well.

The physician orders x-rays and an MRI of Betty’s lumbar spine which shows numerous nerve roots being compressed as they are trying to get out from the spine on the right side. So she has spinal stenosis.

As a diagnostic test, the physician performs a right hip injection under x-ray guidance. Betty’s pain only decreased 20% over the next three days. So the physician sent Betty to a pain doctor the following week who performed an interventional pain management procedure called an epidural injection.

And you know what happened? Betty’s pain decreased another 50% after the first injection and another 20% with the second injection, adding up to a 90% pain reduction with the epidural injections. Both the spinal injections and the hip injection therefore served both a diagnostic and therapeutic purpose.

It is important to keep in mind that pain in and around the hip may in fact be coming either partly or completely from a problem in the spine. This can be the difference between a frustrated patient still in pain versus one who shows dramatic improvement.

David L. Greene, MD, Phoenix, AZ is CEO of Preferred Pain Center which serves the Phoenix and Scottsdale, AZ metropolitan and surrounding areas. He can be reached at dgreene@preferredpaincenter.com and (602) 507-6550.

Preferred Pain Center is a Comprehensive Phoenix Pain Center including Medical and Interventional Pain Management, Phoenix Chiropractor Treatment, Physical Therapy, Spinal Decompression Therapy, Naturopathic Medicine, and Manipulation Under Anesthesia.

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David L Greene - EzineArticles Expert Author