Relief in Moderation: How Epidural Injections Can Help Chronic Back Pain

Back Pain 101

Back pain is an ailment that few fail to encounter at some point in their lives. It can range from a shooting, stabbing sensation to a dull ache, and often leads individuals to request days off work once its disabling effects begin to impact everyday activities. 

Recently cited as the sixth most expensive medical condition in America, back pain contributes to $12 billion a year in healthcare costs. Approximately 65 million Americans experience some form of back pain, whether it be from muscle overuse, prolonged sitting, or incorrect posture. Back pain is considered chronic when symptoms last longer than three months, often resulting from underlying conditions or other factors. Common treatments for chronic back pain include prescription and over-the-counter pain medications, physical therapy, interventional procedures, and in advanced cases, sometimes surgery.

Epidural steroid injections (ESIs) represent a commonly performed therapeutic intervention for relieving persistent back pain. Their effectiveness is proven, but overuse can lead to side effects ranging from mild to severe. Thus,  moderation is key to achieving the perfect balance between maximizing therapeutic relief and minimizing unfavorable side effects.

What is Chronic Back Pain?

Back pain is termed chronic if symptoms like pain and discomfort linger beyond three months, even after initial treatment. Chronic back pain can affect both physical and psychological health because of its impact on quality of life. This persistent condition can be disabling enough to limit everyday activities, due to reduced mobility and efficiency in normal tasks. Psychological manifestations include anxiety, depression, and insomnia due to the chronic nature of the pain, further disrupting sufferers' personal lives. Factors leading to chronic back pain include structural problems in the muscles, inflammatory conditions, or other medical ailments such as osteoporosis, tumors, pregnancy, or fibromyalgia. Healthcare providers use a multifaceted approach to exclude other conditions in the diagnostic process, including a thorough medical and family history, physical examination, and sometimes imaging or blood tests.

What are Epidural Injections?

Epidural steroid injections  (ESIs) are commonly used to alleviate chronic back pain due to their efficacy and minimally invasive nature. Corticosteroids are injected into the epidural space of the spine by a healthcare professional, leveraging their potent anti-inflammatory properties. ESIs are often used to treat conditions causing compression and swelling of the spinal nerves, such as herniated discs, arthritis, strains, and osteoporosis.

Effectiveness of Epidural Injections

For back pain specifically caused by inflammation or nerve irritation, epidural steroid injections can be an effective short-term option for pain relief. Studies confirm that patients often experience significant pain reduction within the first two weeks post-injection. Although the effectiveness of the injection decreases over time, ESIs can help patients begin physical and rehabilitative therapies early, contributing to long-term recovery.

The Importance of Moderation

Healthcare providers caution against the overuse of ESIs due to potential complications and reduced treatment efficacy. Risks associated with overuse include an increased risk of infection, weight gain, elevated blood sugar, loss of bone density, and permanent nerve damage. To mitigate these risks, the American Society of Interventional Pain Physicians (ASIPP) recommends limiting ESIs to a maximum of two to three injections within a six-month period. Insurances typically cover no more than a single ESI every three months, per treatment location. It is important that your pain management specialist understands your frequency of ESI treatment over the months and years that chronic back pain has been managed. 

Conclusion

It is essential for both healthcare providers and patients to optimize the use of ESIs to relieve pain while balancing treatment efficacy and potential side effects. Individuals suffering from chronic back pain can find immediate relief and enhanced quality of life with properly moderated epidural injections. Dr. Matthew Kohler of Ospina Medical offers a number of interventional procedures to relieve complex cases of back pain, so an initial consultation with him may help you find the balance and longterm relief you've been waiting for. 

Written By: Anwar Alhariri

Edited By: Camden Rowe

Medically Reviewed By: Matthew Kohler, MD