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Back Pain Worse After Epidural Steroid Injection

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How Long Flares Last

What You Should Know: Lumbar Epidural Steroid Injections

Cortisone flare reactions are almost always brief, and typically will begin to ease within a few hours or days. That’s especially likely as the cortisone begins to work on the inflammation.

If your symptoms get worse despite ice and over-the-counter pain relief, you should call your healthcare provider. Also call if pain, redness, swelling, or a fever begin several days or weeks after the shot, because that is not a flare reaction. Your healthcare provider can help to diagnose the reason.

Possible Side Effects Of The Steroid

Side effects of steroid injections are usually minimal and go away within one to three days after the procedure. Possible side effects of the steroid include:

  • Facial flushing
  • Low-grade fever
  • For women, temporary changes to your menstrual cycle
  • For people with diabetes, temporary elevation of blood sugar levels

Back Pain After Epidural: Causes And Treatments

When you think about pain relief during labor and delivery, epidurals are the first thing that come to mind. The analgesia is the most commonly used pain relief for laboring women, offering a numbing effect, and is generally a safe and effective option. But some people do report back pain that persists for days, weeks, or even months after the medication wears off. Read on to learn what you need to know about back pain after an epidural, why it happens, and what you can do to ease the symptoms.

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When To Call A Doctor

Serious symptoms following an epidural steroid injection that require immediate medical attention include:

  • Severe headache while sitting up or standing that feels better after lying down, which may indicate a dural puncture
  • A fever of 101 degrees or greater, which may indicate an infection

See When Back Pain May Be a Medical Emergency

Why Might I Need An Epidural Steroid Injection

Lumbar Epidural Injection for Back Pain Treatment

If you have intense, difficult-to-treat pain in your legs or arms from inflamed spinal nerves, then an epidural steroid injection might give you quick relief. Often, nerve passages from the spine to your arms or legs become narrowed, causing this pain. This narrowing can cause inflammation of the spinal nerves.

A number of conditions may add to this narrowing, including:

  • Herniated disks
  • Thickening ligaments in the spine because of spinal arthritis

Injected steroids reduce inflammation and opens up these passages to provides pain relief.

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How Do Epidurals Work

Epidural anesthesia injections work by injecting medication into the epidural space that surrounds the spine, stopping pain signals from traveling to the brain from the spine. This space is filled with fluid and surrounds the spinal cord, acting like a liquid sleeve to protect the critical spinal cord.

The spinal cord is so important because it connects the nerves located all over your body to the brain. For example, if you are injured, the nerve in that area of your body is designed to send a pain signal through your spinal cord to your brain and your back. The epidural anesthetic works by temporarily numbing the spinal nerves, in turn blocking pain signals in certain regions of your body, depending on where along your spine the provider injected the epidural. Depending on the type of drug used, the concentration of that drug, and the dosage, an epidural can provide either temporary pain relief or a temporary complete loss of feeling.

Epidural steroid injections work slightly differently, as they are aimed at managing chronic pain rather than temporary uses. Instead of anesthetic medication, a steroid or corticosteroid is injected into the epidural space around your spine. The steroid then coats the irritated nerve or nerves that are causing pain, working to reduce swelling and giving the nerves time to heal. Epidural steroid injections can result in temporary, long-term, or permanent pain relief.

Neurologic Complicationsneurologic Injury And Neurotoxicity

Similar to the complications listed above, neurotoxicity and neurologic injury are rare and, given the lack of mandatory reporting, as already mentioned, data on the incidence and prevalence of long-term complications from ESI are lacking. Case reports have shown that when neurologic complications do occur they can have devastating effects that lead to long-term and even permanent neurologic deficits and pain. The most common causes of neurologic injury seem to be direct needle trauma to the spinal cord or nerve roots, intra-vascular injection of steroid leading to infarction, and compression of the spinal cord and roots related to an epidural hematoma or abscess . Less commonly, direct compression of the surrounding neurologic structures, for example the dorsal root ganglia, can occur . Indirect compression or injury of the spinal cord and/or nerve roots related to infectious or inflammatory processes, for example abscesses, arachnoiditis, and meningitis, as mentioned above, can also cause neurologic injury. These complications can often be avoided by appropriate patient selection and use of suitable techniques .

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What Is The Outlook For Lumbar Epidural Steroid Injection Therapy

Many people experience temporary pain relief from lumbar epidural steroid injections, and some people even experience longer-term relief lasting up to 12 months. However, some people do not experience any pain relief from ESIs.

The goal of lumbar epidural steroid injection is typically to provide adequate short-term pain relief so that you can begin or continue physical therapy or to try to avoid more intensive pain relief procedures. Physical therapy may help promote long-term pain relief by strengthening the muscles that support your spine.

If a lumbar ESI works for you and results in pain relief, your healthcare provider may recommend another injection later on. However, most providers limit people to two to three ESIs per year.

What To Expect After An Epidural Steroid Injection For Back Pain

Ease Chronic Back Pain With Epidural Steroid Injections

What to expect after an epidural steroid injection for back pain – FAQs

An epidural steroid injection in the low back is a spinal injection to target certain types of low back pain.

If your physician has recommended an epidural steroid injection for your low back pain, you may be wondering what to expect, both during and after the procedure.

In this blog post, we will try to answer some frequently asked questions about the procedure, what to expect, and the steps following it.

What should I expect during the procedure?

You will likely be positioned on a table and an XRY device used to visualize your spine. Various types of anesthesia, including local anesthesia, can be used to decrease pain, anxiety, and numb the area prior to the procedure. If you are using only local anesthesia, you may feel a quick stinging sensation which will last a few seconds while the numbing medication is administered. After to that, you may feel pressure in the area that the physician is working.

Immediately after the procedure.

After the procedure, you’ll be carefully monitored by nursing staff as your sedation wears off. You may feel some discomfort and soreness at the cite of the procedure. An ice pack may be given to you to decrease any swelling at the site of the procedure. Remember, muscle pain/soreness and swelling is normal after a procedure like this. Applying an ice pack to the area intermittently throughout the day can decrease this pain.

In the days following the procedure.

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Pain Seems Worse Now After Epidural


Diagnosed with 2 slipped discs and artheritis, april 2007, 2 weeks ago went in hosital and had epidural injection, the relef was instant, but alas now 2 weeks lata the pain seems to be worse, also skipped a period, which i have read is side effects from the injection, definatly not pregnant, thank god.

I would like to hear from anyone else who has had the epidural injections, and did they work for you?

Been suffering with the pain since october 2006, and not sure what the next step is, im a bit scared about having the operation, any ideas on what other options i have?

Feeling down in the dumps now, after having nearly 2 weeks of no pain, and now its back with a vengance, any information will be greatly recieved.

1 like, 249 replies

  • Posted 14 years ago

    hi there darren, although its been 6months since u applied if u get it they will have 2 pay it all back from the date they recieved ur application, a word of warning thou when the doc comes out u have make sure u dont say stuf like the only way u will get it is if u have no good days at all , these doctors dont no what its like and rem they get paid for doing this so if they can they will refuse good luck 2 u and let me no how u get on Have u considered contacting social work dep they can supply u with some realy good aids to make life a little easier take care xcoly

  • Posted 14 years ago

    No worries about the meds, as I haven’t got any due to the Docs not prescribing me anything that actually works!!!!!!

  • Lumbar Interlaminar Epidural Injections

    A systematic review included 15 fluoroscopically guided randomized trials and 11 nonrandomized studies. The efficacy is good for radiculitis secondary to disk herniation with local anesthetics and steroids and fair with local anesthetic only, whereas it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids and fair for axial pain without disk herniation with local anesthetic with or without steroids.

    A prospective study demonstrated that as compared with conventional lumbar interlaminar epidural injections, the lateral parasagittal interlaminar epidural approach has higher rate of contrast spread into the anterior epidural space.

    It is important to know that at least 3 cases of lumbar paraplegia have been reported, and each developed after interlaminar lumbar epidural steroid injections. The suspected mechanism is similar to a paraplegia caused by a lumbar transforaminal ESI in which the epidural needle penetrates the radicular medullary artery, and the particulate corticosteroid being injected into this artery inside the spinal canal results in an embolism of spinal cord and subsequent paraplegia.

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    What Are The Risks And Possible Complications Of Lumbar Epidural Steroid Injections

    Lumbar epidural steroid injections are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to lumbar ESI injections include:

    • Low blood pressure, which can make you feel lightheaded.
    • Severe headache caused by spinal fluid leakage.
    • Infection from the epidural procedure, such as an epidural abscess, discitis, osteomyelitis or meningitis.
    • Having a negative reaction to the medications, such as hot flashes or a rash.
    • Bleeding if a blood vessel is accidentally damaged during the injection, which could cause a hematoma or a blood clot to form.
    • Damage to the nerves at the injection site.
    • Temporarily losing control of your bladder and bowels. You might need a catheter in your bladder to help you pee.
    • Getting ESI injections too often or receiving higher doses of steroid medication may weaken the bones of your spine or nearby muscles. Because of this, most healthcare providers limit people to two to three ESIs per year.

    How Do I Prepare For A Lumbar Epidural Steroid Injection

    Epidural Steroid Injection Alternative? Resolution of a Large Disc Bulge

    Before your lumbar ESI, its important to tell your healthcare provider if youre pregnant or might be pregnant due to the likely use of fluoroscopy imaging during the procedure. You also need to tell your provider which medications you’re taking, including herbs, supplements and other non-prescription drugs.

    Your healthcare provider will give you specific instructions about what you need to do to prepare for your ESI injection. Be sure to follow their instructions. Your provider may:

    • Limit your eating or drinking for a certain amount of time before your lumbar ESI.
    • Adjust certain medications youre taking, especially blood thinner medications.
    • Request an MRI or CT scan of your back before your lumbar ESI to help determine the exact area that needs to be treated.
    • Make sure you have someone with you to drive you home if youre going to take a sedative for your lumbar ESI.

    Questions that may be helpful to ask your healthcare provider before you get a lumbar epidural steroid injection include:

    • How often do you perform lumbar ESIs?
    • What do I need to do to prepare for my lumbar ESI?
    • What are the risks of getting a lumbar ESI?
    • What will my lumbar ESI feel like?
    • How long will my lumbar ESI last?
    • If a lumbar ESI doesnt relieve my pain, what other options do I have?

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    Safety Of The Transforaminal Approach

    The complications of ESIs can probably be averted by using fluoroscopic guidance, contrast enhancement to avoid vascular uptake, DSA, nonparticulate corticosteroid, and a test dose of local anesthetic before injection of corticosteroid. In the lumbar spine, transforaminal ESI using the Kambin triangle is recommended to avoid needle injury to the radiculomedullary artery or nerve root.

    Cervical transforaminal ESI

    An anatomic study of 95 cervical intervertebral neuroforamina in 10 embalmed cadavers was conducted. Twenty-one arterial branches were found in the posterior aspect of neuroforamina. Seven of them were potential radicular or segmental medullary vessels to the spinal cord. There were variable anastomoses between vertebral arteries and cervical arteries. The study demonstrated that the critical arteries are found in the posterior aspect of the intervertebral neuroforamina and that they may be vulnerable to injection or injury during transforaminal ESI.

    Therefore, aside from the use of live-time fluoroscopy with contrast injection during the cervical transforaminal ESIs to visualize and avoid intravascular injections, the use of smaller-particulate corticosteroid preparations was also recommended to further reduce the risk of central nervous system infarct.

    Additionally, avoidance of heavy sedation during procedures has been recommended to decrease adverse effects.

    Lumbar transforaminal ESI

    Do You Need Epidural Steroid Injections

    If you believe an epidural steroid injection might be the right choice to treat your back pain, we can help you.

    NWA Interventional Pain is a comprehensive pain clinic offering solutions to your chronic pain. We individually tailor your treatment plan to ensure that we treat your pain in the manner that is best for you.

    If youd like to speak with us about your treatment options, use our contact page to get in touch.

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    Rationale For Use Of Steroids In Back Pain

    Since lumbar radicular pain may originate from inflammation of the epidural space and the nerve root, analgesic effects of corticosteroids most likely are related to the following mechanisms:

    • Inhibition of PLA2 and inflammation

    • Inhibition of neural transmission in nociceptive C fibers

    • Reduction of capillary permeability

    How Does A Lumbar Epidural Steroid Injection Work

    Epidural Steroid Injections for Chronic Back Pain

    Healthcare providers may recommend lumbar epidural steroid injections for chronic pain management. Your provider injects a steroid or corticosteroid medication into the epidural space by your spinal cord in your low back.

    The lower back region of your spine is called the lumbar spine. This region is made up of five vertebrae, and these vertebrae are the largest of the other vertebrae in your spine. They extend from your lower thoracic spine to your sacrum .

    Your vertebrae are the 33 individual, interlocking bones that form your spinal column, which runs from the base of your brain to your tailbone. These bones help protect your spinal cord from injury while allowing you to twist and turn. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.

    The five vertebrae in your lumbar spine are named lumbar 1 through lumbar 5 from top to bottom. The lumbar vertebrae have several important roles, including:

    • Supporting and stabilizing your upper body.
    • Allowing twisting and bending movements.
    • Protecting your spinal cord and cauda equina .

    Your spinal cord is a very important bundle of nerves that runs from your brain to your low back. Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can communicate with the rest of your body.

    Read Also: Lower Back Pain Worse After Physical Therapy

    Will I Have Any Restrictions On The Day Of The Procedure

    You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you.

    No heat is to be used in the injected areas for the remainder of the day. You should not take a tub bath, hot shower, or soak in water for the remainder of the day.

    You may eat, drink and take your medications as usual on the day of the procedure unless told otherwise by your doctor.

    When To Seek Professional Help For Back Pain

    Back pain that is not easily remedied with these methods or lasts for a prolonged period of time may require professional help. Data from a 2019 study showed that general postpartum back pain is usually resolved within 6 months of delivery, but you can seek care well before that.

    So when does back pain require a trip to the spine doctor? Any troubling symptoms, like numbness or weakness in the legs, worsening of existing pain, or headaches, should be reported to a doctor or back pain specialist.

    Depending on the symptoms you describe and any problems that appear on diagnostic scans, your provider will create a plan for treatment that fits your needs and lifestyle.

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    What About Epidural Steroid Injections

    For those who use epidurals to manage existing back pain, there may be additional hesitation at the idea of back pain as a side effect. Because most back pain is believed to be related to pregnancy and birth, the risk is much lower in these cases.

    However, these injections are not without risk. Many people experience nausea, headaches, dizziness, flushing, or anxiety as a result of the procedure. These are short-term and usually do not require more treatment than an ice pack.

    Any potential back pain related to these injections would be related to the injection site itself. For this reason, it is important to be sure you go to a trusted provider when seeking epidural steroid injections. They will be able to administer the treatment in the most careful way possible to lower the risk of any injection site problems that could cause nerve complications.

    Whether you recently gave birth or you are seeking experts in epidural steroid injections, AICA Orthopedics has a staff that is ready to help you. Our physical therapists and chiropractors work with pregnant and postpartum women every day and will design plans specific to your needs.

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