What if epidural injections dont work

Preparing for the holidays? Most people who suffer with back pain already know the drill: time heals this wound. Over weeks to months, the pain will calm down, and you will slowly return to your normal life.

In the meantime, try to stay as active as possible and rely as much as possible on over-the-counter pain relievers to help avoid needing cortisone shots. Doctors call these shots corticosteroid injections. But for some, these conservative measures may not relieve the agony soon enough—especially if the problem is back pain caused by irritated spinal nerves. After a few weeks, just getting to the bathroom may start to feel like Napoleon's winter march in Russia.

At that point, you may be offered a cortisone injection to calm the war zone in your lower back. Even for nerve-related back pain, guidelines discourage hasty intervention with cortisone shots. However, if you choose to take a cortisone shot, know its limits.

Shmerling says. Used appropriately, cortisone shots can calm inflamed joints and tissues but do not speed healing or prevent future problems. Here are some of the most common targets for corticosteroid injection therapy:. Cortisone shots are not for ordinary strain-and-sprain backaches. Orthopedic specialists usually offer them for shooting nerve pain sciatica from a ruptured disk, or symptoms associated with narrowing of the space around the spinal cord spinal stenosis.

Even for nerve-related back pain, try the conservative route first, because steroid shots come with risks. Conservative therapy includes the following:. How long should you wait before considering injection therapy? High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs.

Until the results of these studies are available, there is no reason to consider whether the current daily practice of Epidural steroid injections for patients with lumbosacral radicular syndrome should continue. What were these findings? Myths are busted you should not offer Epidural steroid injections in this way:. In January a paper published in the journal Anesthesia and Pain Medicine 3 did offer suggestions that epidural steroid injection complications were rare.

Here are the learning points of that paper. It is clear that Epidural Steroid Injections are a cause of concern to patients and doctors. Recent research cites multiple case reports of neurological complications resulting from epidurals that have led the Food and Drug Administration FDA to issue a warning , requiring label changes, warning of serious neurological events, some resulting in death.

The FDA has identified cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Italian pain specialists writing in the Polish medical journal Anaesthesiology Intensive Therapy 6 simply said this:.

At the very least, a standardized protocol is necessary. Research suggests that a single epidural steroid injection in postmenopausal women adversely affects the bone mineral density of the hip. Enough so that doctors should be considering options when contemplating treatment for radiculopathy. Writing in the medical journal Spine , 7 doctors noted:. Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy.

The resulting decrease in Bone Mineral Density, while slight, suggests that Epidural steroid injections should be used with caution in those at a risk for fracture. In other words, for some women, the temporary relief from back pain can lead to a hip fracture.

Other researchers, however, disagree. While they agree that corticosteroids often result in bone loss and corticosteroid-induced osteoporosis, they say it has nothing to do with bone mineral density because no link has been made between epidural steroid injection and bone mineral density. Further smaller doses are okay. Fortunately, these researchers recognized their limitations: First, this study is limited by the fact that it was retrospective. Second, this study did not consider the use of epidural steroid injection with high-dose corticosteroids.

So the findings do not include long-term high dose steroid use. After further review another South Korean group of researchers came back and published it in the journal Pain Physician: 9.

However, the relationship between epidural steroid injection, bone mineral density, and vertebral fracture remains to be determined. Again, the limitations were that this research was not valid for patients who received high-dose corticosteroids and that the study group was too small to provide an assessment.

Here is a recent study. Clearly, there is a lot of knowledge behind this research. In December , doctors at the University of Virginia and Johns Hopkins Hospital 11 writing in the Global Spine Journal noted that lumbar epidural steroid injection increases the risk of incidental durotomy. Incidental durotomy refers to unintended or accidental tears or puncture of the dura mater during surgery. The steroid weakened this tissue making punctures more common. Spine surgeons and pain specialists should be aware of this association for appropriate preoperative planning and scheduling.

Extra precaution should be taken when operating on patients with a recent history of incidental durotomy. The learning point of this research is that a mild painkiller, such as lidocaine, works just as well as corticosteroids without corticosteroids well know side effects. Repeated injections of either type offered no additional long-term benefit if injections in the first 6 weeks did not improve pain. For some, epidurals did not work beyond 6 weeks or at all, and for those patients, further injections did not offer benefit.

Building on these findings, an international team of researchers published in the journal World Neurosurgery 12 some guidelines of when to consider surgical care and when to consider surgery for problems of degenerative lumbar spinal stenosis.

This uncertainty presents a challenge in making the correct management decisions, especially in patients with mild to moderate symptoms, regarding conservative or surgical treatment.

To standardize clinical practice worldwide as much as possible, the World Federation of Neurosurgical Societies Spine Committee held a consensus conference on conservative treatment for degenerative lumbar spinal stenosis.

Initial conservative treatment could be applied without major complications in these cases. In patients with moderate to severe symptoms or with acute radicular deficits, surgical treatment is indicated. The efficacy of epidural injections is still debated, as it shows only limited benefit in patients with degenerative lumbar spinal stenosis.

In a February study in the journal Anesthesiology and Pain Medicine , 13 researchers confirmed these findings in their own study. However, there is no significant consensus regarding its efficacy. We will often have people tell us that their doctors said that epidurals may or may not work, the effectiveness of treatment may rely on the maximum allowable injections over time.

For some people, this will be effective. For others not. We hear the stories that go like this: I have had lower back pain L Spondylythesis. I had epidural steroid injections over the last three years. The pain is increasing and now radiates into my groin, hips, and legs. I now also have developed numbness. In nearly three decades of helping people with chronic pain problems, we understand that even the smallest pain relief, even for the shortest about of time, is usually better than no pain relief at all.

However, there is always a long-term price to pay for that short-term relief and in many instances, the cost of the short-term pain relief is very high in trying to manage pain in the long run. An April study 14 examined the benefits of Epidural corticosteroid injections in helping patients with lumbosacral radicular pain sciatica with radiating leg pain. This study found that epidural corticosteroid injections probably slightly reduced leg pain and disability at short-term follow-up in people with lumbosacral radicular pain.

In addition, no minor or major adverse events were reported at short-term follow-up after epidural corticosteroid injections or placebo injections.

Although the current review identified additional clinical trials, the available evidence still provides only limited support for the use of epidural corticosteroid injections in people with lumbosacral radicular pain as the treatment effects are small, mainly evident at short-term follow-up and may not be considered clinically important by patients and clinicians i.

A May study in the European Spine Journal 15 examined whether epidural steroid injections are superior to epidural or non-epidural placebo injections in sciatica patients.

To do this they examined the cumulative research of seventeen previously reported articles on the effectiveness of epidural injections for sciatica patients at six weeks, three months, and six-month follow-up.

Secondary outcomes were described qualitatively. Strong conclusions for longer follow-up or for comparisons with non-epidural placebo cannot be drawn due to the generally low quality of evidence and the limited number of studies. Epidural injections can be considered a safe therapy. In other words, Epidural steroid injections can help. They do not help that much more than an epidural placebo injection. In a recent study, published in the medical journal Schmerz Pain , 16 German doctors made a significant discovery.

Chronic lumbar pain syndromes without neurological nerve and muscle deficits can be caused by many problems not just what shows up on an MRI scan looking for back pain. In many cases, a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. But there is a problem with inflammation. A transforaminal epidural injection the injection near the nerve root inflammation into the lumbar region can reduce inflammation and therefore improve temporary treatment outcomes, but it does not repair damage and long-term clinical improvement is lacking.

This agrees with the above research on the lack of long-term effectiveness. In agreement with the previous study that epidural steroid injection does not repair damage and long-term clinical improvement is lacking, is a study 17 where doctors suggest that the only best use of epidural steroid injection is to provide pain relief until spinal surgery can be performed.

What do they base this on? Transforaminal epidural steroid injection is a useful diagnostic, prognostic, and short-term therapeutic tool for lumbar radiculopathy. Although transforaminal epidural steroid injection cannot alter the need for surgery in the long term, it is a reasonably safe procedure to provide short-term pain relief and as a preoperative assessment tool.

As you see in medicine, research into effective treatments for back pain can go on for decades and the problems of the past are still problems today. In November , researchers publishing in the Journal of Pain Research 18 examined the clinical effectiveness of the use of fluoroscopically guided therapeutic selective nerve root block as non-surgical symptom management of lumbar radiculopathy.

The conclusion, as many conclusions are. These injections can help some people. Here is exactly what the study said:. This makes it a very good second line of management after conservative treatment and a possible method to delay, and sometimes cease, the need for surgery.

For many people, the goal is pain relief. Whatever way this can be achieved is seen as a necessary outcome. But are you only masking a worsening situation? Here is a piece of research from doctors at the University of Arizona that makes a very good point that the only best use of epidural steroid injection is to provide pain relief until spinal surgery can be performed.

It was published in in the journal Clinical Biomechanics. The researchers looked at people with degenerative facet arthritis who were treated with medial or intermediate branch nerve block injection.

Then they asked these people about their pain and measured these people with standardized scoring systems for a health condition, disability, objective motor performance measures gait, balance, and timed-up-and-go at pre-surgery , immediately after the injection , one-month , three-month , and month follow-ups.

This suggests that patients perceived pain reduction immediately after spinal injection; however, the pain relief was not reflected in a significant immediate improvement in motor performance. The epidural masked the back pain but did not improve the degenerative disease condition and can put the patient at risk for hurting themselves because they feel less pain and think their back is getting better. Here are a few questions and answers about steroid injection therapy that fails and what can be done about it.

Steroid injections may work for some patients but not for others; results are often unpredictable. Some may get weeks or months of relief, while others will see no relief or very short-term relief. If you don't have pain relief, talk with your healthcare provider.

This may be a sign that the pain is coming from some place other than the spinal nerves. Health Home Conditions and Diseases. Sometimes pain relief is short term. Other times the benefits continue for some time. Why might I need an epidural steroid injection? A number of conditions may add to this narrowing, including: Herniated disks "Slipped" vertebrae Joint cysts Bone spurs Thickening ligaments in the spine because of spinal arthritis Injected steroids reduce inflammation and opens up these passages to provides pain relief.

What are the risks of an epidural steroid injection?