Pain Management

Epidural Injection

What is an Epidural Injection?

An epidural injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation. The epidural space is located outside the dural membrane. Steroids, anesthetics and anti-inflammatory medications are typically delivered in an epidural injection. The injection may reduce pain and swelling in and around the spinal nerve roots, as well as around damaged nerves, which in time may heal.

Imaging guidance, such as fluoroscopy or computed tomography (CT or “CAT” scan), may be used to help the doctor place the needle in exactly the right location so the patient can receive maximum benefit from the injection.

What are some common uses of the procedure?

An epidural injection is one of many methods doctors use to relieve pain, along with physical therapy, nerve blocks, oral medications and surgery.

An epidural injection may be performed to alleviate pain caused by:

  • A herniated or bulging disk
  • Spinal stenosis
  • Other injuries to spinal nerves, vertebrae and surrounding tissues

How should I prepare for the procedure?

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You may be instructed not to eat or drink anything for several hours before your procedure to prevent you from having an upset stomach following the injection.

You may be asked to wear a gown during the procedure.

You will probably be asked to use the restroom before the procedure.

You will then be positioned on your stomach or side on a special fluoroscopic or CT table that will give the doctor easy access to the injection site(s). The nurse will help to make you as comfortable as possible, both during and after the procedure.

You should plan to have a relative or friend drive you home after your procedure.

What does the equipment look like?

The injection itself will be administered with a syringe much like one that would be used for a routine vaccination. The doctor will fill the syringe from a small vial of medication. The type of medication used depends on individual patient needs.

The imaging guidance used, such as fluoroscopy or CT, will require additional equipment around the table. Both types of imaging are painless and involve the use of x-rays to obtain essential images that allow the physician to place the needle in exactly the right location for the injection.

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.

The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.

How does the procedure work?

The different types of medications injected into the epidural space create different effects. Corticosteroids act like an anti-inflammatory agent, reducing swelling and nerve irritation to allow the nerve time to heal itself, thereby preventing further discomfort. By delivering an epidural injection directly into the epidural space, the medication moves throughout the epidural space, coating the nerve roots. Therefore, a lumbar injection could affect the lower back and the nerves traveling to the lower limbs, such as the sciatic nerves.

Similarly, if an epidural injection is performed in the neck, it should spread throughout the cervical epidural space and provide relief to nerve roots in the neck. Unfortunately, oftentimes the results of the epidural injection may not be long lasting. A patient may experience relief for a matter of days up to several months, however, the pain may eventually return, requiring either another injection or an alternative treatment.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some procedures may require admission. Please consult with your physician.

An epidural injection usually takes only minutes to administer.

When you arrive at the office, hospital or surgical center, the nurse may place an intravenous (IV) line in your arm to deliver a relaxation medication during the procedure; this is seldom needed but will be available if required. You will be situated on your stomach or on your side, on a table in the fluoroscopic room or in computed tomography room and made to feel as comfortable as possible.

The doctor will identify where the injection should be given and will sterilize the skin with an antiseptic solution. He or she will then inject a local anesthetic to help numb the area before administering the epidural injection.

Once the area is numb, the doctor will most likely use imaging guidance to help guide the epidural needle to exactly the right position. When the needle is in place, a contrast material will be injected so the doctor can ensure the distribution of the medication given. Then, your doctor will slowly inject the medication, which is typically a combination of anesthetic and anti-inflammatory drugs (cortisone/steroids).

When finished, you will be moved into a chair or bed and allowed to rest for a few minutes to an hour. The nurse will make sure you do not have any unfavorable reactions to the medication before you are allowed to leave.

What will I experience during the procedure?

You may have no sensation whatsoever, however you may feel tingling or pressure when the injection is administered. Depending on the amount of swelling in the area, you may experience a burning sensation or some mild discomfort as the medication enters the epidural space. When the injection is finished, however, any discomfort usually disappears. It is possible to feel “pins and needles” in your arms and legs, depending on the injection site. If you feel any sharp pains, however, tell your doctor immediately.

Due to the numbness and any discomfort you may experience after the procedure, you may have some difficulty walking on your own and getting in and out of the car. This is normal and should subside in a matter of hours. You should take it easy for the rest of the day, though, and may resume normal activities the next day.

The epidural may not take effect immediately—it is common for improvement in the pain to occur progressively over the first 48 hours. The effects may last for a matter of days, weeks, and occasionally months.

Who interprets the results and how do I get them?

A radiologist will perform the epidural injection.

The doctor who delivers the injection will follow up with you to see how you are doing and determine if further action is required. Any imaging that is performed during the procedure itself will conclude with the procedure, and no follow-up image interpretation is necessary.

 

Nerve Blocks

What is a Nerve Block?

A nerve block is an anesthetic or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain. The purpose of the injection is to “turn off” a pain signal coming from a specific location in the body or to decrease inflammation in that area.

Imaging guidance, such as fluoroscopy or computed tomography (CT or “CAT” scan), may be used to help the doctor place the needle in exactly the right location so that the patient can receive maximum benefit from the injection.

What are some common uses of the procedure?

People who suffer from either acute or chronic pain might have a nerve block injection to achieve temporary pain relief. Often such pain originates from the spine, but other areas commonly affected include the neck, buttocks, legs and arms. Delivering a nerve block injection allows a damaged nerve time to heal itself from a state of constant irritation. Additionally, nerve blocks can provide diagnostic information to the doctor. By performing a nerve block and then monitoring how the patient responds to the injection, the doctor can often use this information to help determine the cause or source of the pain.

How should I prepare for the procedure?

Usually, no special preparation is required prior to arrival for a nerve block procedure.

You may be asked to wear a gown during the procedure.

You will probably be asked to use the restroom before the procedure.

You will then be positioned on your stomach or side on a special fluoroscopic or CT table that will give the doctor easy access to the injection site(s). The nurse will help to make you as comfortable as possible, both during and after the procedure.

What does the equipment look like?

The injection itself will be administered with a syringe much like one that would be used for a routine vaccination. The doctor will fill the syringe from a small vial of medication. The type of medication used depends on individual patient needs.

The imaging guidance used, such as fluoroscopy or CT, will require additional equipment around the table. Both types of imaging are painless and involve the use of x-rays to obtain essential images that allow the physician to place the needle in exactly the right location for the injection.

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.

The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.

How does the procedure work?

The medication delivered by the injection will be placed as close to the site of pain as possible. It will then “shut down” the pain receptors within the nerve(s) causing the problem. Imaging can help the doctor place the needle in exactly the right spot. The imaging itself is painless.

The effects of the injection are usually immediate. It only takes a short time for the medication to achieve pain relief. However, nerve blocks are only a temporary fix—they typically last for up to one or two weeks and then wear off as they are absorbed by your body. Some patients undergo several rounds of nerve blocks before they feel a more permanent sense of relief. Others may not receive any permanent pain relief from this type of injection and may require different treatment methods to manage the pain or inflammation.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some procedures may require admission. Please consult with your physician.

Nerve blocks usually take only minutes to administer.

You will be positioned on a table or other surface to allow the doctor access to the site(s) to be injected. The doctor will then identify the spot the needle needs to be placed, using palpation and/or imaging guidance. He or she will clean the area with antiseptic solution, and then the needle will be inserted at a specific depth to deliver the medication as close to the problematic nerve(s) as possible.

More than one injection may be required, depending on how many areas of pain you have or how large an area needs to be covered. The doctor will most likely tell you when he or she inserts the needle and when the injection is done.

When finished, you will be allowed to rest for 15 to 30 minutes to let the medication take effect. The nurse will also make sure you don’t have any unexpected side effects before you leave the doctor’s office.

What will I experience during the procedure?

You will probably feel a “pinch” when the needle is inserted. As soon as the medication is delivered, though, you should feel less discomfort. Sometimes the needle has to be inserted fairly deep to reach the nerve causing your problem. This can be temporarily uncomfortable, but it is important to hold still so that the needle is inserted correctly.

If you require an injection close to a major nerve or bundle of nerves, such as the sciatic nerve, your doctor will tell you to speak up if you get a sudden jolt of pain. This means that the needle has come too close to the major nerve and will need to be retracted and re-positioned. This happens rarely, however, so it should not be a major concern.

After the injection, you will probably experience a sensation of pain relief in the area injected. This will typically last up to one or two weeks, or even permanently in some cases.

Who interprets the results and how do I get them?

A radiologist will perform the nerve block injection.

The doctor who delivers the injections will follow up with you to see how you are doing and determine if further action is required. Any imaging that is performed during the procedure itself will conclude with the procedure, and no follow-up image interpretation is necessary.