The epidural space extends from the base of the skull to the sacrum. It is composed of fatty tissue and blood vessels. The epidural space surrounds the dura, the tough covering that holds in the spinal fluid.

Epidural steroid injections may be used for a variety of pain syndromes. These include back pain, postherpetic neuralgia, diabetic neuropathies, RSD, phantom limb pain, disc disease, spinal stenosis, or as diagnostic procedures. The areas in which we inject will depend on the location of your pain. The introduction of anesthetics and steroids into the epidural space may reduce the inflammation and associated pain of irritated nerves or bulging discs.

Upon arrival to The Pain Treatment Center, nursing personnel will start an IV and prepare you for your procedure. In the operating room, your blood pressure and heart rate will be monitored. Occasionally, patients are given small amounts of sedation prior to the procedure. If you are given sedation, you should experience reduced anxiety and pain with partial or total amnesia. Epidural injections are performed in the sitting position with your arms resting on a support or with you lying on your stomach. If the cervical or caudal approaches are used, the injection will be done under a special X-ray machine while you lie on your stomach.

The area around the injection site will be cleaned with iodine soap and sterilely draped. Local anesthetic will be injected into the skin to numb the injection site. A special epidural needle will be placed into the epidural space and a mixture of local anesthetic and long-acting steroids will be injected into the epidural space which is immediately outside the spinal canal.

• Backache from bone bruising.
• Spinal headache or total spinal, if the dura is inadvertently punctured.
• Small risk of bleeding or infection at injection sites.
• Although very rare, damage to the spinal cord or spinal nerves may result in paralysis or partial muscle weakness or persistent numbness. Injury to blood vessels could occur.
• Rarely, reactions to the anesthetic drugs can cause flushing, ringing in your ears, or in very rare instances, seizures or respiratory depression.
• Allergic reactions to medications may cause your heart and breathing to stop or may cause death.

• Your blood pressure may decrease.
• Your legs may feel weak or numb for a short time after the injection.
• You may have difficulty urinating (especially men) for a short time after the procedure. If you experience difficulty urinating and have pain in your bladder, go to the closest emergency room for catheterization. Tell the emergency room that you have had an epidural injection.
• You may experience some soreness at the injection site or fullness in the back for 1-2 days. If the pain or numbness becomes much worse after leaving the Center, please call The Pain Treatment Center or the on-call doctor.

A single epidural injection will usually decrease pain significantly. However, it is common for the pain to return after some period of time. The length of time for decreased pain usually becomes longer after each injection. Therefore, it is common to provide three or more epidural injections before ultimately controlling the pain. To be most effective, epidural injections should be combined with programmed exercises. Your pain management doctor can discuss types of exercise with you. Your doctor may also recommend that you schedule an appointment with our Behavioral Medicine doctors to discuss stress management techniques. You may also be asked to stop smoking.