Neurogenic Pain: Can it be treated with Epidural Steroid Injections?

By Christina Lasich, MD

Most people who experience “sciatica” are really experiencing the shooting, searing sensation of neurogenic pain (pain coming from a nerve) as discussed in the previous article, “Sciatica: What is it?” As mentioned, nerve pain can affect both the arms and legs depending on whether the pinched nerve is in the neck or low back. When a nerve is pinched by a herniated disc, the nerve becomes inflamed. Thus, the most potent anti-inflammatory medications, steroids, are used to control the inflammation around the nerve and stop the nerve pain. These steroids are placed next to the nerve by a procedure called an epidural steroid injection (ESI). For the past 50 years, millions of dollars have been spent on epidurals despite the fact that these injections do not cure the problem. ESI’s only temporarily provide symptom relief for nerve pain.

Sally, a young woman who has just herniated a disc, still has burning pain that goes all the way down her leg. Relentlessly, the pain has not responded to the oral anti-inflammatory medications recommended by her doctor. She is unable to sleep and unable to walk. Now, she returns to her doctor because she needs more relief. After ordering an MRI, the doctor confirms that her disc herniation is at L4-5. He recommends an epidural steroid injection to help control the inflammation and pain from the pinched nerve. She says, “Whoa doc, before you start placing needles in my back, tell me what the risks are?”

Epidural steroid injections are not without risks. Infection is the biggest risk anytime a needle is involved. The actual procedure can also cause headaches, increased pain (usually temporary) or a drop in blood pressure (dizziness). The lumbar injections have less chance of complications than the cervical injections. This fact is due to the smaller, confined space in the neck that places critical things like the spinal cord and blood vessels in close proximity to the sharp tip of the needle. Because a steroid is used, this medication has its own side effects like nausea, blood sugar abnormalities, insomnia, or flushing. So, Sally needs to weigh these risks against the potential benefits. In fact, the short term benefits of pain relief can be expected to last up to 60 days in 75% of people like Sally who have a lumbar ESI. The chances for success start to decline for people who have lumbar stenosis, have had pain longer than six months, or have had prior surgery.

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