Many patients have Frequently Asked Questions (FAQs). Many of these questions relate to the injections and procedures performed by Dr. Lee. He will answer some of the more common questions, which generally relate to Epidural Steroid Injections (ESI).
1. What is the difference between “cortisone” and “steriod” shot or injection?
Cortisone is a type of steroid, and this term, “cortisone” is used nowadays to mean many types of different steroid injections. In actuality, there are different steroid drugs your doctor may provide, such as Depomedrol (methylprednisolone) and Kenalog (triamcinolone). These are long acting steriods commonly used for pain injections.
2. What is an “Epidural” or “Epidural shot”?
The proper name is actually “Epidural Steroid Injection” of either the Cervical (neck), Thoracic (mid back) or Lumbar (lower back) spine. This is the most common steroid injection for spinal related pain. The epidural space is the area in the spinal canal where spinal nerve roots are located and the most effective space to deposit powerful anti-inflammatory drugs, such as steroids, to “counteract” and “neutralize” the inflammation (usually in the spinal nerves) that is causing your pain (for example, back or neck pain).
3. Aren’t steroids bad for me? I hear about athletes using “steroids” in the media.
There are two main types of steroids, catabolic and anabolic steroids. The type that is “abused”, as you hear about in the media, is the anabolic steroids. To treat pain, your doctor will be using the catabolic steroids mentioned above. Although there are side effects, they are usually minimal and do NOT affect the majority of patients, especially as you will not be getting injections continuously, day after day or week after week. Your doctor will be able to warn you if you are at increased risk for side effects.
4. How many steriod injections will I receive?
The number of injections will depend on your response and the severity of your painful condition. But, traditionally, steroid injections such as epidural steriod injections for neck or back pain are given in series of up to 3 injections, between 2-4 week intervals. As mentioned, not everyone requires all 3 to be effective. In fact, many patients will receive at least 50% or more relief with just one injection.
5. How long will the pain relief last from my injection(s)?
Again, the pain relief duration, like response, varies from patient to patient, due to individual variability and the severity of a patient’s painful condition. In general, the majority of patients will respond to the steroid injections, and can expect relief for months or even years. There will be a small minority of patients who respond only minimally or not at all. Unfortunately, it is hard for the doctor to predict if you will be in the majority or minority. In most cases, you will have to obtain the injection(s) in order to determine your own response.
6. Am I only allowed just one cortisone/epidural injection series for my lifetime?
There seems to be a common misconception among patients and the public that one can only receive one or a series of steroid injections, such as epidural steroid injections, in his/her lifetime. Nothing is further from the truth. Since the steriod’s effects would fade with time, it is only natural that you may require another injection or series of injections in the future. For example, one does not expect taking one blood pressure pill to control his/her blood pressure for a lifetime. There is no guideline on the set number of steriod injections you can receive in a year, as different doctors use different drugs and dosages. But, a patient may need repeat injections periodically, whether they be months or years apart, to continue having optimal pain relief.
7. I am fearful of the pain involved in an epidural steroid injection. Isn’t it the same as a labor epidural?
Many patients are fearful of the pain involved in steroid injections, especially ESIs. Some have heard unpleasant “stories” of labor epidurals for pregnant women during delivery. Be assured that although the procedure is similar, there are also subtle differences that make an epidural steroid injection in general a more pleasant experience. The epidural needle used by Dr. Lee is commonly much smaller than for a labor epidural. Furthermore, the procedure will be done under fluroscopic (X-ray) guidance, which localizes the target exactly and so the doctor can make the injection usually with one attempt, without “going by feel”, which is often done with labor epidurals. To further enhance the patient’s comfort level, unless contraindicated, most patients will receive conscious sedation (i.e. “twilight sleep”). In fact, many patients are unaware that the procedure has already been done.
8. Will my disc bulge/herniation “shrink back” with an epidural steroid injection (ESI)?
Once again, an ESI is meant to decrease the inflammation in the spinal nerves, which is usually the cause for most patient’s spinal pain (e.g. neck or back). The bulging or herniated disc may or may not “shrink back” with time, as this depends on your own body and the severity of your problem. However, you may get good to excellent pain relief even if the disc bulge/herniation persist after your ESI(s), once the inflammation resolves in in the spinal nerve(s). Sometimes, Dr. Lee may advise other treatments, including surgery, to correct your spinal problem.
9. I received an “epidural” in the past an it didn’t work. Why would another one help me?
As mentioned above, there will be a minority of patients who will not respond to an epidural or series of epidural steroid injections. However, there may be multiple factors why the original injection(s) failed. Your diagnoses may have been different or your condition changed over time. Furthermore, each doctor may have a slightly different technique or drug mixture that can make the difference between an effective response vs. failure. Just as importantly, many different spinal injections are lumped as “epidurals”, when in fact they were something different. There are many structures that can contribute to pain in your neck or back, including nerves, discs, ligaments, spinal joints (e.g. facet joints), muscles, and even the skin. There are different types of injections for different structures. So, just because you did not respond to ”epidurals” in the past does not mean you will not respond in the future. The most important task for you is to find a doctor who will do a thorough examination and conclude with an accurate diagnosis or set of diagnoses so that you can receive the correct treatment plan.
10. What if the epidural steroid injections do not help?
As mentioned above, there may be more than one spinal structure causing your spine pain. Sometimes, there are multiple causes for your spine pain or radiculopathy. In this case, Dr. Lee may recommend alternative treatment options or steriod injections. For example, if your sciatica/leg pain or hand pain improves with epidural steroid injection but you still have low back pain or neck pain, you may benefit from facet joint injections. But, whatever the case, you will need further evaluation by Dr. Lee to decide on further treatment. Remember that there are multiple treatments available now for pain and just because one method yielded partial or no response DOES NOT necessarily mean you will “just have to live with the pain”!
The information provided here is solely the opinion of Dr. Lee and SCCPM and is not meant to be a subsitution for professional medical advice and evaluation. Please see the Disclaimer Tab for more details.