There is not much worse pain in the world than lower back pain in my estimation. It stops you in your tracks and makes life completely miserable. You can’t lie down comfortably, stand up without pain, bend over without screaming in pain, or cough without thinking the world is coming to an end. Forget sneezing. It is out of the question. When people seek my services for relief of this pain, I respect the lower back pain sufferers. We do all that we can to accommodate them as quickly as possible. One such person sought relief at our office in the past month but had received a procedure from his doctor in another town and was worse than he was before the procedure. His doctor had prescribed a series of steroid injections into his spine and something went wrong during the event. Since then more than one person has asked about epidural steroid injections, so I decided to investigate.
Epidural steroid injections involve the injection of steroid medications through the muscles of the back into an area of the spine which is just outside the sac which contains cerebrospinal fluid. That is a mouthful, but some knowledge of anatomy is helpful in understanding this subject. The steroid medication has an anti-inflammatory property, and will theoretically stop pain by reducing the swelling of the nerve roots as they exit at different levels of the spine. The epidural steroid injections do not correct any conditions which might exist such as vertebral subluxations or bulging discs, but are administered with the hope of alleviating some of the pain that these conditions cause. These injections are usually administered in a series of 3 and are given about a month apart. It takes a week or two for them to take full effect, so the timing is important to get the longest term relief.
The injections are not without risk, however. The National Health and Medical Research Council of Australia report from 1994 stated that the risk of puncturing the dural sac (the one that contains cerebrospinal fluid) is, on the average, at least 5%. If this happens, the spinal fluid often leaks and causes among other things exceptionally severe headaches. This was the case for the patient I mentioned earlier. Fluid was leaking from his spine, and the complications were almost unbearable. This same report also warns that epidural steroid injections carry a very high risk of direct entry into the space containing cerebrospinal fluid in patients who have had previous spinal surgery. Some common risks involving these injections are backache (Isn’t that why they were done in the first place?!), puncture headache, nausea, vomiting, and dizziness. Less common occurrences include epidural hematoma, nerve root injury, meningitis, and arachnoiditis.
The liquid form of the drugs which are used to bring about the anti-inflammatory effects contain preservatives such as polyethylene glycol, which is better known as anti-freeze used in cars. This is a well-recognized toxin. In one study done on laboratory rats, epidural steroid injections were administered to the sciatic nerves of the rats. Nerves treated with these agents showed damage including scar formation and demyelination, or removal of the protective coating of the nerves.
Many people are being treated with epidural steroid injections for back pain relief but several researchers have questioned the effectiveness of them. In one peer-reviewed medical journal article, the authors concluded that “…overall results were poor, with only 50% of patients receiving temporary relief and less than 25% of patients receiving long-term benefit.” Other studies which were in favor of the injections state that their effectiveness depends on the length of time the patient has had symptoms. The longer the patient has suffered, the less effective the injections are. It seems that if epidural steroidal injections are performed using fluoroscopy (live, real time x-ray), they seem to be more precisely placed and are therefore more effective.
The time has come for all of us to be vigilant in making sure that we are aware of what is being done to our bodies. Ask questions. Be fully aware of the risks versus the benefits of any procedure, and make informed decisions regarding your healthcare. Make sure you have fully explored every conservative option before you embark upon more invasive procedures, and treat your body well.