Epidurals are one of the most effective ways of treating pain and other issues in the spinal column. As a minimally-invasive method of delivering drugs and medication straight to the body, these injections play a vital role in keeping many back-related conditions like spinal stenosis and sciatica manageable. Epidural steroid injections have seen marked success in treating acute and chronic pain, with long-term results.
But what if there’s increased pain after a lumbar epidural steroid injection? Typically this indicates post-injection pain or sensitivity. This is a mild side-effect that should subside within a day, and shouldn’t be too painful for you. Any deviation from this characteristic should be taken as the beginning of a serious complication and reported immediately to a doctor.
Why epidural steroid injections can be painful?
An epidural steroid injection is a shot delivered straight to your spine, which is the center of your body’s nervous system. It’s most commonly used to inject steroids and pain medication in the nerve clusters that handle the body’s pain signals, shutting them down and temporarily stifling their effects.
But because the spine is near so many nerve clusters in the body, doctors have to be extraordinary with this procedure so they don’t cause any harm to the patient. The nervous system can be very sensitive to outside shocks like needle injections, and an epidural can have many adverse effects if incorrectly applied by the injector.
The proximity of so many nerves also means that the injection is more likely to be painful compared to other procedures. Since the needle will have to pass through several nerve clusters and straight into the spinal column, patients are likely to feel some level of pain and discomfort even if anesthesia is used. More anxious patients can request sedation.
However, a skilled injector should be able to bypass most of the nerve clusters in the spine to get the needle to where it needs to go. The entire process can take only minutes, with only half an hour of after-procedure examination to ensure that you don’t have any adverse reactions to the medication. Overall, epidurals are a relatively simple procedure to perform for experienced doctors and should bring little in the way of side effects to the patient.
Potential risks and complications of an epidural
However, that doesn’t mean that this procedure doesn’t have risks. There are three frequent complications usually associated with performing an epidural:
1. Dural puncture
A dural puncture is when the needle accidentally punctures through the membrane layer called the meninges. This layer surrounds the spinal cord and keeps the fluids that travel into the brain, which can cause symptoms like headaches, loss of vision, and dizziness.
The risk of this occurring is fairly low, and most patients that experience it recover after a day or two and sufficient medical treatment. However, it is still the most common risk that an epidural has, and you’ll be likely briefed by the doctor and nurse on the exact things to do once it happens.
2. Nerve damage
In rare cases, the needle can damage a cluster of nerves on the way to the spinal column which can affect minor to major body functions. This is a relatively uncommon risk that can still be treated with immediate medical attention, though the prognosis depends on how many nerves were affected by the procedure.
One thing to note about nerve damage is that it may manifest after the procedure is already over. Because most epidurals usually involve some topical anesthetic, it’s not uncommon for patients who do experience nerve damage to be unaware until days after the procedure. However, with early enough detection and treatment, any long-lasting effects can be avoided.
Nerve damage does not always manifest in acute or chronic pain. Sometimes it can be numbness, loss of feeling, tingling, or a burning sensation near or around the injection site. So, all patients are held for an hour after their epidural to determine if any damage was done to the spinal column.
Finally, it’s possible for the entry site into the spine to be infected by viruses or bacteria. While this is highly unlikely if the injection is performed in a sterile environment, it can still be a risk that can occur if the patient or the doctor goes about the procedure recklessly.
Infections are very serious complications since they can rapidly spread along the spine into the brain, or shut down essential parts of the body. If the patient suspects at any point that their epidural site has become infected, they should receive urgent medical care immediately.
But overall, these risks are minor and are hardly experienced by anyone who goes through epidurals. The side effects that you’re most likely going to experience are tenderness around the injection site, some headaches, and maybe some increased sensitivity to pain for a day or two.
What to expect after an epidural steroid injection
So what should you expect exactly after an epidural?
The first thing to note is that while it’s injected straight into the spine, the medication used in epidurals won’t take effect immediately. On average, it takes about a day to a week for a patient to feel the effects of an epidural, so they’ll most likely have to take it easy for a day and a half after the procedure.
Here are some considerations you’ll need to keep in mind directly after the epidural is done:
1. Minimal movement to avoid tenderness and sensitivity
Because of the aforementioned proximity to most of the nerves in the body, most patients are advised a solid day or two of bed rest after an epidural. Not only does this help the medication disperse better throughout the body, but it also helps the patient cope with the physical recovery after having a sensitive procedure done.
Even though it’s a minimally invasive procedure, epidurals can still take quite a toll on the patient. Lumbar epidural steroid injections in particular can have effects like tenderness, inflammation, and sensitive skin around the injection site. If you’ve recently received an epidural, your doctor will advise that you stay put for as long as you can until your body recovers.
2. Concerns about medication
The medications used in epidurals have a high efficacy rate of removing pain, but because they take a while to kick in, patients are advised to wait before the effects take hold. Once this happens, they are to monitor themselves until they’ve established that most if not all the pain they’re experiencing has been alleviated or gone.
One secondary concern that nurses and doctors will have about epidurals is the patient’s reaction to the anesthetic used. If you have an allergic reaction to any of the compounds or tools used in the epidural, your doctor will hold you until medical treatment is done to make the symptoms go away.
3. Repeated injection
The most important thing to note is while epidurals are effective at treating pain, they’re not long-term solutions. Patients will need regular epidurals to manage chronic pain and to lessen the effects of sudden onsets of acute pain. If you need an epidural to manage a spinal condition, you’ll likely need to have another injection fairly soon.
Keeping up with this treatment regimen is crucial for patients who have advanced spinal conditions like scoliosis and spinal stenosis. Not only does this make other pain management and treatment methods easier, but it can slow down the progression of these conditions when combined with the right treatments.
Any lingering pain that you feel after an epidural is completely normal, but the one thing to keep in mind is that any pain you experience at all should always fade within one to two days. The pain being treated by your epidural should also subside within a week, and should remain manageable until the next scheduled epidural.
At most, you’ll only experience some inflammation, tenderness, and discomfort that can be treated with home remedies like hot and cold therapy. The most effective way you can decrease the pain after an epidural is to follow your doctor’s advice and take a day of bed rest.
Manage Your Back Pain At SOS Physio Rehab
Some pain after epidural steroid injections is normal, but one thing to keep in mind is that this side effect doesn’t happen to everyone and it definitely shouldn’t be too painful. If the levels of pain you experience are intense or stay after a day of bed rest, contact your doctor immediately. Any pain after an epidural should be diagnosed to prevent further complications from occurring.
SOS Physio Rehab is a proud partner and advisor to patients, helping them manage their back pain and improve their spinal health. We provide personalized and innovative treatments to most spinal conditions, combining them with emphatic patient care. For more information on us and the services that we can provide, visit one of our clinics today.
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