What is an epidural steroid injection?

An epidural steroid injection is an injection of local anesthetic (numbing medicine) and steroid medication (Kenalog or depomedrol) into the epidural space. The epidural space is located in the spine just outside the membrane that covers the spinal cord and nerve roots. This membrane is called the dural membrane. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structures of the spine.

The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. This is done by injecting an anti-inflammatory medicine into the epidural space. An epidural steroid injection will not correct the pre-existing medical problem (i.e., spinal stenosis, herniated or bulging disc, arthritis, etc.), but it may improve the level of pain.

It is not unusual for a patient to require more than one injection to receive long term benefit. The injections are done in a series of three about 3-4 weeks apart, if needed. If the pain significantly improves, no further injection is needed unless the pain begins to come back.

Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety!

How do I prepare for my procedure?

No solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before arriving at the PMC. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication.

Please make your Pain Management doctor aware that you are taking a blood thinner, and contact your primary care physician or prescribing physician before stopping this medication.

What happens during the actual procedure?

After the doctor examines you and goes over the risks and benefits of the procedure, he or she will ask you to sign a consent form. Then, you will be assisted to the X-ray table and made as comfortable as possible lying on your stomach. Blood pressure and heart monitors will be put in place. You may have an intravenous (IV) catheter placed before the procedure, through which you may receive fluid and medication to make you more comfortable.

Your back or neck is then cleansed with alcohol and an antiseptic solution. A sterile drape is placed, and your skin is anesthetized (numbed) with a local anesthetic. You may feel a temporary stinging or burning sensation at this time. Under X-ray guidance, a small needle is then advanced into the epidural space. Pressure is the usual sensation felt during this procedure. If pain is felt, more local anesthetic will be used.

Once in the epidural space, X-ray dye will be injected to confirm the correct location of the needle, and the steroid mixture will then be injected, completing the procedure. (Please let the nurses and doctors know if you have ever had an allergic reaction to X-ray dye or shellfish!) After the injection, your skin will be washed and a band aid will be applied. Your blood pressure will be monitored in the recovery area for an appropriate time (usually 20-40 minutes) and you may be offered juice/soda and graham crackers. You will be given written and oral discharge instructions. You may go home with your driver after your doctor authorizes discharge.

How will I feel after the injection?

You may experience temporary relief after this procedure that may last several hours. Once the numbing medication wears off, your pain may return. The steroid medication usually takes two or three days to begin having an effect in most people; therefore, it may be a while before you feel a change in your pain. In rare cases, your pain may increase for a few days before improving.

Some local tenderness may also be experienced for a couple of days after the injection. Using an ice pack three or four times a day will help alleviate this. You may take your usual pain medications after the injection. Diabetics may see a short-term elevation of blood sugars from the steroid medication.

Will I have any restrictions on the day of the procedure?

You may not drive for the remainder of the day after your procedure. A responsible adult (over 18 years old) must be present to drive you home or to go with you in a taxi. The procedure will be cancelled if you don't have a responsible adult with you! This is for your safety.

No heat is to be used on the injected area for the remainder of the day. No tub bath, shower or soaking in water (i.e. pool, hot tub, etc.) for the remainder of the day.

You may resume normal diet and medications after the procedure unless told otherwise by your doctor.

When Should I call the Pain Management Center?

We would like speak to you the day after your procedure regarding your response. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain score, and if you are experiencing any problems.

If you experience severe pain, new numbness or weakness of your arms or legs, a temperature of 100.5 or greater, a severe headache that doesn't go away with your usual headache medication, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call the Pain Management Center immediately at 410-448-6824 to have the pain management physician on call paged to your number.

For more information or to make an appointment, call the University of Maryland Pain Management Center at 410-448-6824.