Epidural Steroid Injections: Frequently Asked Questions

 What is an Epidural Steroid Injection?

An “ESI” or simply “Epidural” is a painless, non-surgical, non-invasive treatment that was introduced in the 1950s. Today, we offer this common procedure at NJ Pain Care Specialists using the latest and safest technology.

When performing an ESI, one of our experienced physicians injects a local numbing anesthetic and steroidal anti-inflammatory medication into the sleeve-like passage surrounding the spinal sac – known as the epidural space. If you suffer from a condition such as a herniated disc, sciatica or spinal stenosis, your spinal nerves can become inflamed due to narrowing of the epidural passages where the nerves travel as they pass down or out of your spine – causing pain in the back and legs. ESI relieves this pain by reducing the inflammation.

How do I prepare for an ESI?

When you schedule an appointment for an ESI, let us know if you’re taking a blood thinner such as Plavix or Coumadin and our staff will tell you how long before you should stop using it (and also be sure to contact your primary care physician or prescribing physician before you do).

In the morning you may take medications with small sips of water. If you’re diabetic, don’t take your medication for diabetes until after the procedure is complete. And please check your blood sugar at home before you leave for your appointment.

Do not eat solid food or drink fluids after midnight the night before unless told otherwise.

You must arrange to have a responsible adult – 18 or older – with you at the procedure to drive you home (or accompany you in a taxi). Your procedure will be rescheduled if you do not have someone with you to see you home safely!

Important! If you develop an active infection, flu, cold, fever, very high blood pressure, or if you took a medication after your stop date – make our staff aware of it and we will reschedule your procedure for your own safety!

What happens during the ESI procedure at NJ Pain Care Specialists?

  • Before you begin, you can request a mild sedative to relieve any anxiety and help you feel more relaxed (a majority of patients do fine without it)
  • You lie flat on an x-ray table on your abdomen and your skin is numbed with a local anesthetic
  • Your experienced pain management physician carefully guides a thin needle into the open space where the irritated nerve roots are located
  • A contrast agent is injected and a fluoroscope live x-ray device confirms that the tip of the needle is positioned properly
  • A steroid/anesthetic medication is then injected to bathe the irritated nerve roots. It is believed the injection also has a flushing effect that helps remove or “flush out” inflammatory proteins from around structures that might be causing pain
  • After a short recovery period, you’ll be sent home to take it easy for the rest of the day

How will I feel after the ESI?

You might experience temporary relief that could last several hours. Once the numbing medication wears off, your pain could return until the steroid medication takes effect in 2-3 days. In rare cases, your pain may increase for a few days before improving.

To help alleviate any local tenderness, apply an ice pack three or four times a day.

You can resume your normal diet and usual pain medications. Diabetics may see a short-term elevation of blood sugars from the steroid.

Will I have any restrictions on the day of the ESI?

  • No driving for the rest of the day.
  • No heat on the injected area.
  • No tub bath, shower, hot tub or swimming pool.
  • In most cases, you can go back to work and other activities the following morning, unless told otherwise by your doctor.

Will I need additional treatments?

You may feel significant relief after just a single 20-to-30-minute procedure. However, it is not unusual for a patient to require more than one injection to get long-term benefit. If needed, the injections are done in a series of three about 3-4 weeks apart. If the pain significantly improves, no further injections are needed unless the pain returns.

What’s the long-term expectation?

The steroids will not change the underlying condition that causes your pain. However, you may feel significant relief after just a single procedure. Importantly, it can break the cycle of pain and inflammation and allow you to undergo physical therapy and rehabilitation, to exercise, and to heal. So, ultimately, the injections can provide benefits that outlast the effects of the steroid itself.

I’ve found that this can be a highly effective treatment because it delivers the medication and pain relief directly to the source of the problem. For more information, call NJ Pain Care Specialists at 732-720-0247.