Sally agrees to have the spinal injection and schedules an appointment. Because she will be mildly sedated, she needs to have her friend drive her to and from the appointment. She is at the out-patient surgery center for about two hours. Since the doctor used X-ray guidance, he is confident that the medication got in the right spot. He injected a combination of a local anesthetic (for immediate effect) and a steroid (for long term relief). She was told to take it easy for the remainder of the day and refrain from driving for the next couple of days. Within the week, she notices substantially less pain in her leg. Finally, she can get some sleep.
Can Sally expect some long-term benefits? Typically, the pain relief from an epidural steroid injection last a matter of weeks. Hopefully with the temporary relief, Sally can start a physical therapy program and modify her life enough so that the pain does not come back with such intensity. Sometimes, this temporary relief is all that is needed to start the recovery process. Because ESI’s jump start the rehabilitation process, they are done despite the risks and great financial costs. However, looking beyond the temporary symptom relief is the prospect of preventing chronic pain.
Although unproven, the science behind the harmful effects of inflammation is a compelling argument to aggressively control inflammation. This chemical reaction, called inflammation, can spread like a fire and can cause permanent changes in the nervous system. These changes can lead to a sensitized, irritated nerve that will not stop sending pain signals to the brain. Like any fire, it is best to extinguish the flames before a wildfire erupts and gets out of control. Because epidural steroid injections hose the area around the nerve off with cooling medications, the inflammation is quickly contained. Catching a fire early is probably why steroid injections work best when done within the first six months from an injury. This is also why epidural steroid injections are not typically used for chronic pain. By that time, the fire is already out of control and more permanent, long-term solutions need to be implemented.
