living with back pain

Epidural steroid injections deliver medication directly (or very near) the source of pain generation. In contrast, oral steroids and painkillers have a dispersed, less-focused impact and may have unacceptable side effects. An epidural steroid injection delivers steroids directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ inflammatory mediators from around the area that may be a source of pain.

Epidural injections are often used to treat radicular pain, also called sciatica, which is pain that radiates from the site of a pinched nerve in the low back to the area of the body aligned with that nerve, such as the back of the leg or into the foot. Inflammatory chemicals (e.g. substance P, PLA2, arachidonic acid, TNF-α, IL-1, and prostaglandin E2) and immunologic mediators can generate pain and are associated with common back problems such as lumbar disc herniation or facet joint arthritis. These conditions, as well as many others, provoke inflammation that in turn can cause significant nerve root irritation and swelling.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine or bupivacaine), and/or saline is used.

Steroids inhibit the inflammatory response caused by chemical and mechanical sources of pain. Steroids also work by reducing the activity of the immune system to react to inflammation associated with nerve or tissue damage. A typical immune response is the body generating white blood cells and chemicals to protect it against infection and foreign substances such as bacteria and viruses. Inhibiting the immune response with an epidural steroid injection can reduce the pain associated with inflammation.

Several common conditions that cause radiculopathy – severe acute or chronic low back pain and/or leg pain – (sciatica) that can be treated with steroid injections include:

A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves. 

Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back. 

Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain. 

You will lie face down on a table or special bed. The doctor might give you a sedating medication. The epidural injection takes place in several steps:

•The skin will be cleaned and injected with an anesthetic to numb it.

•The doctor will insert a needle through the skin toward the spine.

•The doctor will use a machine that produces live X-ray video called fluoroscopy. With it, the doctor will maneuver the needle between the bones of the spine.

•Using a contrast dye, the doctor will confirm the needle is placed in the epidural space. That’s the space between the spine and the spinal cord inside it.

•When the needle is in position, the doctor will inject a solution into the epidural space. The solution contains a steroid medicine, also called corticosteroid, and usually an anesthetic medicine, too.

•The epidural injection is usually not painful because of the numbing medicine used at the start. Many people do have mild tenderness for up to a few days after the injection.

Although many studies document the short-term benefits of epidural steroid injections, the data on long-term effectiveness are less available. Indeed, the effectiveness of lumbar epidural steroid injections continues to be a topic of debate. This is accentuated by the lack of properly performed studies.

For example, many studies do not include use of fluoroscopy or X-ray to verify proper placement of the medication despite the fact that fluoroscopic guidance is routinely used today. Additionally, many studies do not classify patients according to diagnosis and tend to ‘lump’ different types sources of pain together. These methodological flaws tend to make interpretation and application of study results difficult to impossible.

The patients that we’ve treated at Michigan Sports and Spine Center have reported significant pain relief after the injections. The reason for that is injections are only part of the treatment plan. We continue care after the injections with medications, physical therapy, and home exercise programs that help patients get back to the life they love.

Most people have back pain at some point in their lives. Most of the time, back pain symptoms aren’t due to a serious health issue such as arthritis or a fracture. In fact, the culprit could be as innocent as your mattress or your favorite pair of shoes. 

If you experience back pain after an injury or if your back pain is severe or lasts more than a few days, see your doctor. In the meantime, be aware that some of your everyday habits could be contributing to your pain.

CAUSE #1: YOU IGNORE YOUR CORE

Your core supports all of your movements. It is composed of your back, side, pelvic, and buttock muscles and they all work together, along with your abs, to allow you to bend, twist, rotate, and stand upright. 

WHAT TO DO ABOUT IT: Keep those muscles in top shape to support your spine with simple core exercises — lunges, squats, planks, and others — that will strengthen several spine-supporting muscle groups at once.

CAUSE #2: YOU’RE STRESS OUT

Many people hold emotional stress in their muscles, especially the muscles of the neck and shoulders. You might know this stress as a tension headache that starts in 
the back of your neck and moves up and down from there. What actually causes the pain? Well, normally, blood flows through the muscles of your neck and back with very little resistance. However, when you are emotionally stressed, certain muscles may tense up and squeeze these blood vessels. Like a garden hose with a kink in it, the flow of blood can get constricted or even cut off by these tense muscles. When your neck and back are not getting their proper blood supply, they let you know it with pain. 

WHAT TO DO ABOUT IT: Try mood enhancers like exercise, meditation, yoga, and deep breathing; they can help ease stress and make you feel better.

CAUSE #3: YOUR MATTRESS

Regardless of your slumber sweet spot, go with a medium mattress and a pillow that keeps your head in line with your spine. Research has shown that people with chronic low-back pain who slept on medium mattresses had fewer aches after three months than those who slept on firm beds. 

WHAT TO DO ABOUT IT: Your bed should be not too hard (this wreaks havoc on hips and shoulders) and not too soft (this puts your back and joints out of whack). 

CAUSE #4: YOU SMOKE

Smoking isn’t just bad for your heart and lungs! Smokers have a higher incidence of recurring back problems for many reasons. Nicotine restricts blood flow to vertebrae and disks, so they may age and break down more quickly. It also interferes with the body’s ability to absorb and use calcium, leading to osteoporosis-related bone and back problems. Smoking deprives cells all over your body of oxygen, even those in your back. Studies show that smokers are more than twice as likely to develop lower back pain as those who have never smoked.  

                                            WHAT TO DO ABOUT IT: Quit. 

CAUSE #5: YOUR SHOES

We all have heard that sky-high stilettos are a no-no, but it turns out that our favorite summer sandals and flip-flops can cause trouble, too. They provide little, if any, arch support which over time can lead to back, knee, and foot problems. 

WHAT TO DO ABOUT IT:  Alternate styles throughout the week — from high to low, sneakers to sandals — and avoid wearing a particular pair every day. Shoes should also fit properly and offer good arch and heel support. So, go shoe shopping! 

CAUSE #6: YOUR POSTURE

Poor posture and slumped shoulders also factor among back pain causes. Your ears should be over your shoulders, your shoulders over your hip joints, and your hips over your ankles. With everyone now staring at their phones and devices most of the day, this is a growing cause of neck and back pain. 

WHAT TO DO ABOUT IT: Make a conscious effort to maintain good posture during the day to ease or help prevent back pain. Take a break from electronic devices.

CAUSE #7: YOUR INACTIVE LIFESTYLE

Physical inactivity coupled with a high body mass index (BMI) increases the risk of having chronic lower back pain and neck pain. With so many of us sitting at computers all day, in our cars, talking and texting on our phones, and in front of our TVs, it’s no wonder that we have higher BMIs and lower physical activity. But that can be remedied easily. 

WHAT TO DO ABOUT IT: Exercise gives you the muscle tone needed to support your back and keep it pain-free. Your bones need the strength of your muscles and ligaments to keep them in place. Keeping your back tight and strong with exercise will help you avoid back pain. Low-impact activities like walking and swimming boost blood flow to back muscles while relieving pain and stiffness. Yoga can also be a very effective because of its emphasis on stretching and strengthening. A study in the Archives of Internal Medicine reported that after three months of weekly yoga sessions, 60 percent of back-pain sufferers reported less discomfort, and 40 percent were able to cut back on pain meds.