Free Conquer Back and Neck Pain - Walk It Off! by Mark Brown Page A

The high doses of oral steroids required to be effective can cause some rare but harmful side effects, such as an increase in blood sugar (diabetes), loss of bone mass (osteoporosis), bleeding ulcer in your stomach, and destruction of the hip joint (aseptic necrosis of the hip). These bad side effects from steroids taken by mouth are not as common when they are given by epidural injection.
    A specialist should perform the epidural injection using fluoroscopy (moving x-ray picture) to accurately place the steroid in the exact region of the painful nerve. I refer my patients to another specialist (anesthesiologist or physiatrist) to perform epidural injections. Your doctor may perform the epidural or may refer you to another specialist to have it performed.
What should I expect when I have an epidural?
    First, a disclaimer: Unlike an MRI scan, I have personally never had an epidural, therefore I am relating to you what patients have told me about their experience with the procedure. Most patients say that it is not a very painful procedure, but a few patients do complain of experiencing a temporary increase in pain at the time of the injection. This is particularly true when the steroid is injected into the area of an irritated nerve. You can request sedation when it is being performed, but some patients do not want it. The injection includes a local anesthetic along with the steroid medication, which should give you some immediate pain relief. Immediate pain relief from the local anesthetic is an indication that the correct area was injected. I write a prescription stating the exact level and side of the herniated disc so that the doctor who is performing the procedure will know exactly where I want the injection to be placed. Accurate placement of the steroid is confirmed when the patient has immediate relief of pain from the local anesthetic in the injection. Immediate relief of your pain at the time of the epidural injection also helps to confirm the diagnosis that the disc herniation seen on your MRI scan is the actual cause of your pain.
What are the possible side effects from an epidural?
    Diabetic patients may see a temporary increase in their blood sugar following an epidural. They should monitor their blood sugar closely for a few days following the injection. However, I have not seen a diabetic patient develop any permanent trouble from the transient elevation of blood sugar following an epidural.
    Rarely, a patient may experience a spinal headache. A spinal headache results from leakage of spinal fluid when the needle causes a hole in the sac (dura) that contains the nerves. Years ago I had a spinal headache following spinal anesthesia for knee surgery. I experienced intense pain behind my eyes when I stood up and it went away immediately when I lay down. This is typically how patients describe a spinal headache. It usually goes away after a few days, but it can be very disturbing to say the least. At times a blood patch is required to stop the leak and relieve the headache (blood is taken from a vein in your arm and then injected into the epidural space to seal the spinal fluid leak). Spinal headache from spinal fluid leakage is seen more often in patients who have had more than three epidural injections. This is one of the reasons I limit the number of epidurals I will prescribe to my patients to three in a six-month period. The other reason for limiting the number of epidural steroid injections is that if three injections that lessen local inflammation do not give lasting relief of pain, then the irritating source of the problem is not being taken care of. So, if the nerve in your back continues to be irritated and painful despite three epidurals within a six-month period, then it is time to consider other options, such as surgery.
    In over 35 years of practice, I have seen only two patients who developed an infection following an epidural steroid injection. Both patients were heavy smokers; smokers are