During most procedures, an IV needle will be placed in your arm in case any medication is needed during the procedure.  Blood pressure and pulse are monitored.  The procedure takes 30-60 minutes.  NUMBING MEDICATION IS USED LIBERALLY AND IN MOST CASES THE PROCEDURE IS NOT SIGNIFICANTLY PAINFUL.  You should plan on having a ride home.

The purpose of the injection is to carry medication to the inner part of the spine where the more serious types of strain and injury can affect the disc and spinal joints, causing pressure or irritation of the nerves, or pain arising from the joints.  In most cases, the medication that is going to be used is a very potent anti-inflammatory steroid.  Many doctors and patients refer to this medication as "cortisone", although hydrocortisone is rarely used anymore.  There are better types of medication similar to hydrocortisone. In this office, we usually use triamcinolone which is the same family of medications as cortisone.  The goal of the injection is to deliver this potent anti-inflammatory steroid as close as possible to the anatomical structure that we believe is causing your pain, thus providing the greatest chance of pain relief.

Much misinformation exist with regards to cortisone-type medications.  It is very true that when an anti-inflammatory steroid, such as prednisone, has to be taken daily, it can cause significant side effects.  Many patients with conditions such as rheumatoid arthritis, lupus, or patients who have had organ transplants, have to take oral steroids on a daily basis.  When this medication is used daily, common adverse side effects include loss of bone density, weight gain, glaucoma, stomach ulceration, and other undesirable problems.  IT MUST BE EMPHASIZED THAT THERE IS NO SATISFACTORY EVIDENCE OF ANY LONG TERM COMPLICATION FROM THE USE OF ANTI-INFLAMMATORY STEROIDS INJECTED IN THE EPIDURAL SPACE OR WITHIN A JOINT.

Minor or temporary reactions may result from the use of the cortisone-type medication and these are rather frequent.  The day following the procedure, some patients may develop a facial flush which usually lasts 12 to 24 hours.  Occasionally, some women can experience some disruption in their menstrual cycle for 1 or 2 cycles.  Extremely rarely, a patient could develop an acute allergic reaction to the anti-inflammatory steroid, and this could be treated promptly with medications during the procedure.  Diabetic patients will often experience an increase in their blood sugars which can last for 5 to 7 days.

Most medical professionals who treat patients by injections of anti-inflammatory steroids feel that it is very safe to inject the same joint or epidural space up to three times per year.

In the great majority of cases, these injections are not significantly painful procedures.  Numbing medication is used which involves a small needle stick and burning sensation, similar to dental work.  Once the numbing medication is in, the shot is relatively easy to tolerate, for the most part.  Occasionally, a patient can experience a sharp electric-type sensation down the arm or leg for just a split second.  This is not alarming and simply means that the needle is being put in an effective place close to the nerve.  This does not cause nerve injury.  During an epidural injection, you may experience some mild dizziness which may last for a few minutes.  This is generally due to a drop in blood pressure and resolves quickly.  Intravenous fluids can be administered if the dizziness does not resolve quickly.

Due to the numbing medicines, some patients experience numbness in the arms or legs after the procedure.  The numbing medicine wears off in one to eight hours, causing the numbness or weakness to go away.

Increased pain is often experienced the evening after the injection and the following day.  Although unusual, this pain may last up to seven days.  The benefits from the cortisone-type medication injected generally take 24 to 72 hours to occur.  Occasionally, it can take seven days for beneficial affects to occur.  The medication usually reaches its peak effect by two weeks.

Many patients ask how long the injection will last or if the injection "wears off".  Simply put, the medication is a potent anti-inflammatory and will cause a reduction in inflammation and pain in the area where it is injected.  If the injection relieves 75% to 100% of your pain one to two weeks after the injection, most likely the results will be long lasting.  This assumes that the problem that caused the inflammation in the first place is removed.  Sometimes the injection will not work at all.  This usually means one of two things.

2. Another possibility is that the medicine was put in the proper place, but that the problem causing your pain, such as a large slipped disc or severe spinal stenosis, is too great to be overcome by a simple injection.  When this is the case, the patient will generally experience some very minor pain relief for several days and then the pain will be as bad as it was previously.  When this occurs, it is generally not worthwhile performing any further injections.

Patients often achieve pain relief that is lasting.  If indicated, we do a second or third injection to further any benefits that are gained from the first injection.  Performing up to three injections is considered very safe and is a common protocol for many physicians who do these procedures.  Often, the injection is performed just once as this is all that is needed to provide lasting relief.

We hope this information sheet has been able to answer some common questions regarding spinal injections.  Certainly, if there are further questions, we would be happy to discuss them with you.