Regenerative Medicine

What to Expect if Epidural Steroid Injections Don’t Work

By Last updated on October 14th, 2020 Last updated on October 14th, 2020 No Comments

Millions of Americans suffer from some form of back pain on a regular basis. When pain is too much to bear, or if pain is impacting daily activities, it’s time to see a medical professional. There are many treatments available for back pain. Some of the more common treatments include posture correction, medication, and physical therapy. Another popular treatment for chronic pain is corticosteroid injections. Many patients see positive results with these injections, but there are common side effects that should be taken into consideration when deciding on a treatment plan. Read on to learn about what these injections are, how they work, risks to be aware of, and alternative treatment methods for back pain.

What Are Epidural Steroid Injections?

The epidural space in the spine exists inside the vertebral wall, and surrounds another membrane called the dura mater. contains veins, nerve roots, fat, connective tissue, and many more vital components. The purpose of the epidural space is to protect these components. It also provides extra room for the spine to move around and absorbs shock.

Space surrounding the spine is meant for protection, but this tissue can become inflamed and place stress on nerves. Compressed nerves can lead to pain in the back, pain or numbness in the extremities, and a tingling sensation depending on where the compression has occurred. Some other symptoms may be associated with the condition, so it is important to discuss any potential symptoms with a doctor, even if they seem irrelevant.

Cortisol is a hormone that is released naturally by the body. Blood sugar levels, inflammation, and metabolism can all be affected by cortisol levels. Epidural steroid injections contain a synthetic form of cortisol called cortisone. Causing an increased amount of cortisol can reduce swelling and therefore pain associated with the injury.

Doctors use an X-Ray or other imaging technology to ensure that the needle is injected in the location that will reduce the most inflammation. Many injections also include a local anesthetic to reduce pain that may occur as the injection is happening. The location of the injection depends on where the pain is located, and can occur in the upper (cervical), middle (thoracic), or lower (lumbar) portions of the spine.

Conditions That May be Treated With Epidural Steroid Injections

Treating back pain can be difficult, as the spine and the nerves inside can be delicate. Due to the complex nature of nerves and the space surrounding them, many symptoms do not appear as just pain. Other possible symptoms of a back injury include:

  • Pain in hands or feet
  • Pain that radiates down the arms or legs
  • Numbness
  • Tingling sensation
  • Muscle spasms

Steroid injections have been used to treat pain throughout the body. Patients with chronic joint pain often consider this form of treatment for pain relief as well as patients with back pain. These injections are often coupled with other treatment such as physical therapy and medication.

Conditions of the spine that may be treated with steroid injections include:

  • Spinal Stenosis: the spinal canal can narrow and create pressure on nerves and spinal cord. This may result in pain, numbness, tingling, or a sensation of weakness.
  • Herniated or Slipped Disc: discs are a piece of cartilage that exist between the bony vertebrae in the spine. Discs work to absorb shock, help with flexibility, and reduce the likelihood that bones will rub against one another. The soft inner part of the disc can leak out of the disc, causing pain and discomfort.
  • Spondylolisthesis: vertebrae can slip out of place, which may in turn apply pressure to the spinal canal. The condition may cause pain and other nerve-related symptoms such as tingling or numbness.
  • Bone Spurs: extra growth on bones is another condition that may lead to pain and inflammation.

There are many ways in which a doctor may diagnose and treat these conditions, depending on the individual patient’s needs. Any condition that involves inflammation causing the compression of nerves may benefit from these injections. Due to the potential side effects, some conditions such as high blood pressure or arthritis may impact a doctor’s decision to use them.

Risks of Steroid Injections and Why They May Not Work

Epidural steroid injections are generally considered safe by the medical community, which is why they have been used to treat pain for decades. Recent findings, however, have proven that there are potentially harmful components to the injections.

Repeated treatment via steroids can impact the body in many different ways. Some of the most common side effects can include those which are typical of many steroid treatments:

  • Irritability
  • Anxiety
  • Restlessness
  • Allergic Reaction
  • Increased Pain
  • Bleeding
  • High Blood Sugar
  • Headaches

It is important to maintain an open line of communication with doctors, as other symptoms may also occur. These side effects are rare, but should be considered when making the decision to undergo this treatment.

Though side effects may seem daunting, there is a greater risk associated with steroid injections – it has been proven that repeated injections can deteriorate soft tissue over time. For this reason, many practitioners place a limit on the amount of injections they will perform. This treatment is not often used in the long term as it does not treat the underlying issue, rather, the issue becomes tolerable.

Epidural steroid injections may not deliver the expected results. Doctors can often recommend other options that may relieve pain, though these can be dangerous too – they may prescribe opioids, a highly addictive pain medication, for example.

Back surgery is rare, but some patients may face a surgical option if all other conventional treatments have failed. Some alternative treatments offer to treat conditions to the point where surgery is no longer necessary, such as stem cell therapy.

Some patients have opted to explore alternative treatments to avoid the side effects and potential worsening of their condition.

Alternative Treatments for Back Pain

Reduced pain can lead to more involved physical therapy, greater enjoyment of life, and ability to return to tasks that weren’t possible due to symptoms. This is why many doctors following the conventional path focus on pain relief.

There may be an option that offers not only pain relief, but treatment of the underlying condition as well. The field of Regenerative Medicine seeks to use the body’s own naturally occurring healing cells to enhance the recovery process. CELLAXYS offers two types of regenerative therapy:

  • Stem Cell Therapy: stem cells are located throughout the body, and contain the ability to help cells regenerate once they have been damaged. Cells are procured using a blood sample, fat tissue, or bone marrow. The cells are then processed and injected into the area where pain is most intense. Increasing the amount of regenerating cells can help damaged cells recover while simultaneously reducing pain.
  • Platelet-Rich Plasma (PRP) Therapy: blood cells contain many important components, one of which is called platelets. These cells contain proteins and healing factors that can reduce inflammation and call to other healing cells such as stem cells. The procedure of receiving PRP therapy is similar to that of stem cell therapy. Once blood is drawn from the patient it is placed in a centrifuge that helps to concentrate the platelets. The solution is then injected into the problem area.

Both forms of regenerative medicine involve outpatient appointments that take under two hours. The most common side effect is some pain around the injection site. As these treatments are utilizing a patient’s own cells, the risk of rejection, allergic reactions, and other adverse effects is significantly reduced.

Doctors use imaging techniques such as ultrasound or MRI (Magnetic Resonance Imaging) to locate the exact point where the needle should be entered.

These therapies have seen significantly positive results and continue to be a viable option for chronic pain sufferers. Unlike some conventional treatment methods, regenerative medicine seeks to reduce pain and simultaneously treat the underlying cause. Some patients are even able to avoid surgery or other intrusive treatment methods.

Conclusion

Back pain is one of the most common chronic pain conditions in the United States. Most adults have experienced some form of back pain in their lifetime, leading to a vast array of treatments and remedies. Some conditions can heal on their own with home treatments – which may not work. Conventional treatments have been helping patients for decades but may come with unforeseen complications. For this reason, it is important to talk to a doctor about what is the best option to meet individual needs. When deciding on a recovery plan, some patients benefit from considering a wider array of treatment options outside the conventional path.

Dr. Pouya Mohajer

Dr. Pouya Mohajer

Director of Spine & Interventional Medicine
Board certification in Anesthesiology and Interventional Pain Medicine
Fellowship-trained from Harvard University
UCLA Alumni