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More About Interventional Pain Management - Page 2
Epidural steroid injections
Epidural steroid injections (ESIs) involve the introduction of relatively high concentrations of cortisone type medications into the spinal space “closer” to the source of the pain. It is fortunate in many situations that cortisone type medications, injected locally (or taken orally), prove interventional as they interrupt the inflammatory, painful process improving the environment for a natural healing process to take place; in this situation the source of the pain may never be known.
The apparent success of ESIs in the treatment of many types of pain has made “epidural” a household name. ESIs provide excellent short-term relief in the vast majority of patients however the pain often returns over time in a large percentage of patients. It is the amount of time that it takes for the pain to return to baseline that usually defines “success or failure” a definition that varies significantly by healthcare provider. In this context, ESIs can actually complicate the isolation of the pain culprit: there is usually excellent short-term relief followed by variable intermediate to long-term pain relief that is often just barely beneficial enough that more direct interventional procedures are not explored. Patients in chronic pain are usually grateful for any pain relief so the concept of “holding out for better” is sometimes a difficult decision for a patient to make.
It is in this type of situation that the precise origin of pain becomes important. There are multiple sources for back pain including facet joints, nerve roots, discs and sacroiliac joints each requiring a unique interventional pain procedure. Facet joints have been implicated as the source of pain in as much as 45% for low back, 48% for thoracic and 67% for neck pain. Disc related pain has been implicated in 26 - 39% for low back and 61% for neck pain. Sacroiliac joint pain has been implicated in 10 - 30% of patients with low back pain. ESIs are generally not effective treatment in a large percentage of the described sources of pain. Back to page 1.