The steroid injection itself may cause a temporary increase in pain. As with many types of “shots”, the tissue around the injection site can be distressed, causing pain, swelling, and soreness. Pain and swelling from the injection will usually diminish in a matter of days. Each case is different, so patients will experience varying degrees and lengths of symptom relief. It is important to note that steroids are only a temporary solution for back pain. If the underlying cause of pain is severe, surgical treatment may eventually be required.
Caudal epidural steroid injections involve injecting a steroid into the epidural space, where the irritated nerve roots are located. The caudal injection is performed through the sacral opening and is used to treat low back pain. This injection includes both a long-lasting steroid and an anesthetic (lidocaine, bupivacaine). The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain-spasm cycle and nociceptor transmission (Boswell 2007). The medicines spread to the most painful levels of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.
Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.