Delivered to an area around the spinal cord and nerve roots called the epidural space, epidural injections can provide immediate relief. Unlike medications taken orally, injections target the affected area directly. Patients who respond well to epidural injections may experience enough relief to actively participate in physical therapy exercises that strengthen spine-supporting muscle groups. Here is a list of 3 common agents often used in epidural spinal injections to provide relief, brought to you by The Spine Institute, Santa Monica’s top choice for spine surgery. Santa Monica patients can learn about these agents below.
1. Cortisone (Corticosteroid)
Cortisone is a synthetic version of cortisol, a steroid naturally produced by adrenal glands. The cortisone medications typically used in epidural spinal injections mimic the effects of this anti-inflammatory agent. It can be effective since most spine-related pain is aggravated by some degree of inflammation that irritates nearby nerve roots when tissues become swollen.
2. Local Anesthetic
The purpose of a local anesthetic is twofold. First, it numbs the area where the injection will be administered to make the patient more comfortable during what’s typically an in-office procedure. Second, the anesthetic also provides immediate (but temporary) pain relief.
There are several medications that may be used as a local anesthetic, but lidocaine is among the most commonly used with epidural injections. These are short-acting anesthetics that usually wear off within a few hours. Bupivacaine, a longer lasting local anesthetic, is sometimes used as well, and it can also ease pain by flushing out some of the chemicals released from the body’s white blood cells that cause inflammation.
A doctor may only inject a local anesthetic into the affected location to determine how the patient reacts. If there is no noticeable relief from pain, it may be assumed there is another source of discomfort that hasn’t been identified yet. If a patient does experience relief, another injection with a corticosteroid may be given to allow the relief to last longer.
Some patients may experience an increase in pain when the local anesthetic wears off, typically a temporary spike in pain that goes away once the steroid medication starts to work on tissues in the affected area. It usually takes about 2-7 days for the cortisone to start working.
A mixture of sodium chloride and water is sometimes included in epidural spinal injections. Saline acts to dilute the local anesthetic, which may wash out histamine and other chemicals that typically trigger inflammation.
Epidural injections are used to treat multiple sources of spine-related discomfort, including disc herniation, degenerative disc disease, and abnormalities affecting nerve roots like spinal stenosis. The treatment may provide relief that lasts anywhere from several days to several months. Though injections do not treat the underlying causes of nerve irritation, they allow patients to benefit from other treatments without distracting pain. Possible side effects are generally mild. Since epidural injections may damage soft tissues, they shouldn’t be administered to the same area more than 3-4 times a year.
At The Spine Institute, we offer spinal injections as well as a variety of other procedures, from traditional spinal fusion to total disc replacement surgery. Santa Monica residents should call 310-828-7757 today to speak with one of our friendly representatives.