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Is a Lumbar Epidural the Right Solution for My Pain?

In the clinic, I’m frequently asked whether or not an epidural is a good solution for my patients’ lower back issues, sciatica, leg pain, numbness and/or weakness.

“Tom, will an epidural stop my pain and discomfort?”

 

The answer to that question, in all honesty, is that no one really knows for sure. (**If your physician guarantees that it will help you, immediately walk out of their office and grab your medical records on the way out the door!)

Studies indicate that overall, the success rates of costly epidural injections range from merely 50 – 80%. These studies have shown a poor response to lumbar epidural steroid injections for stenosis, a longer hospital stay, and an increase in pain medication usage following surgery. (Typically, if injections are performed within the first six weeks of the start of pain, rates of success are higher than if they are performed after this six-week mark.)

A research article published in the Annals of Internal Medicine in 2012 demonstrated minimal reduction of “sciatica” symptoms in the first year, but no central / low back pain relief. The concern is that the origin of the pain was not identified. I like to provide my patients with this analogy: if you continue to hit your hand with a hammer, don’t expect medications to remedy the pain. With sciatica, excessive SITTING is often the hammer.

Additionally, although they are considered relatively safe, lumbar epidural injections carry several possible side effects. These include: infection, bleeding, nerve damage and headaches.

Although I do agree that in some cases, an epidural injection can be the right course of action to pursue, it’s absolutely not appropriate for everyone. In my opinion, the injections shouldn’t be approached as a “quick fix”. Trust me, I understand that when you’re in pain and uncomfortable, and it’s affecting your lifestyle, you are willing to try anything to make it go away as quickly as possible.

Before you consider lumbar epidural injections, I recommend asking yourself the following questions:

1. Are my symptoms below the buttock into the legs or feet? (The injection success rate is higher for leg pain, not necessarily central lumbar pain.)

2. Have I made attempts at conservative care (physical therapy, chiropractic, acupuncture)?

3. Have I experienced failure in the past of oral non-steroidal anti-inflammatory and steroid based anti-inflammatories?

4. Have I experienced a rapid worsening of symptoms, including: weakness, tingling, dull achiness, numbness, or burning expecially if it begins to travel down the legs when it had not been present.

5. Have I attempted to make ergonomic changes to my workstation and vehicles that I drive?

If you answered “YES” to all of the above questions, perhaps lumbar epidural injections should be in the cards for you.

My goal in writing this blog is for my patients have a well thought-out reason to pursue lumbar epidural injections. I agree that in some cases the lumbar epidural injection is necessary to explore as the next step in your treatment.

Contact a physician immediately if you have any of the following RED FLAGS in addition to your current symptoms:

• Bladder or bowel incontinence
• Urinary retention (with overflow incontinence)
• Unexplained weight loss or weight gain
• Progressive weakness in the lower extremities
• Difficulty walking
• Severe night pain
• Saddle numbness
• Severe pain with coughing, sneezing or laughing
• Recent onset of balance difficulties
• Pain that increases or is unrelieved by rest
• Constant pain that doesn’t vary with changing positions
• Persistent fever or infection
• Significant trauma related to age (e.g. fall from a height or motor vehicle accident in a young patient, minor fall or heavy lifting in a potentially osteoporotic or older patient, or a person with possible osteoporosis)

For some tips on how to treat your own back pain / discomfort and treat the reason for your low back or sciatica pain, download my FREE Stop Back Pain Report NOW! (COMING SOON!)

If you have a few questions that you’d like answered personally, please take advantage of our FREE phone consultation by calling 201-639-4116.

Apex Orthopedic Rehabilitation in Paramus, NJ provides orthopedic, spine and sports physical therapy services for the greater Ridgewood, Paramus, and Bergen County region. This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your doctor or healthcare practitioner before engaging in a physical therapy or rehabilitative program.

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