Sept 6, 2008

Sciatica and Epidural Injections - Risks and Side Effects

So far in this series we've discussed what epidural injections are, what they are not, and how to determine if you are a candidate for the procedure.

What we haven't discussed are the risks and potential side effects that go along with getting these injections.

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Since we all want to be informed consumers, let's first take a look at the risks involved with epidural steroid injections.

There is Always a Risk

Every form of medical intervention involves risks and potential side effects.

There are risks involved with simply taking an aspirin or over-the-counter cold remedy. There are even risks associated with taking vitamins and herbal supplements especially when you're taking them for medicinal purposes.

So it should come as no shock that there are risks that you need to be aware of before you decide to undergo a series of epidural steroid injections. Here are the main ones:

Infection

There is always the risk of infection whenever you undergo an invasive medical procedure. With an epidural injection, your doctor will be puncturing the skin and injecting medication into the lumbar region of your back.

Fortunately, serious infections from this procedure are rare (less than one tenth of a percent) and minor infections only occur in about 2% of all patients.

Dural Puncture

A dural puncture sometimes does occur, however this is also extremely rare. When this does happen, it can result in a headache that normally clears up in a couple of days. If it doesn't, there is a simple procedure called a blood patch that your doctor can use to stop the leak.

Bleeding

Bleeding caused by the injection is also extremely rare and usually only occurs in patients who have a bleeding disorder.

Nerve Damage

Whenever you stick sharp objects into your body, there is always the possibility that some nerve damage can occur. This might be the result of a nerve coming in direct contact with the needle or from one of the other risks mentioned above such as an infection. Again, this is extremely rare, but something you should be aware of just the same.

What are the Side Effects

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In addition to the risks mentioned above, a small number of patients will experience some form of side effect from the medication. These are usually temporary - lasting no more than a day or two - but can include one or more of the following:

The only long-term side effects associated with corticosteroids appear to be the result of excessive or prolonged steroid usage - not due to the limited number of injections we're talking about. These included such things as stomach ulcers, cataracts, osteoporosis and arthritis.

Again, these disorders have only been shown to occur in people with long-term use of corticosteroids and not to people who merely undergo epidural injection for sciatica. In other words, they don't really apply to this discussion.

Who Should Not Get the Injections

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Lumbar epidural steroid injections should not be performed if you have any of the following:

  1. Bacterial infection
  2. Bleeding problems
  3. Back pain due to a tumor or infection
  4. High blood pressure
  5. Diabetes

In addition, you should not get the injections if you are pregnant, if you are allergic to the medication, or if you are on blood thinners such as aspirin or Plavix.

Cover All Your Bases

As always, be sure to inform your primary care physician that you are considering this procedure so that you can discuss any medical conditions that might affect the outcome. Then be sure to inform the doctor performing the injections about any of these conditions.

He or she will attempt to minimize the risks and potential side effects by administering the lowest dose possible. And will also be more than happy to discuss everything we've discussed here and answer any additional questions you have in more detail.

Next time we'll wrap this series up by going over exactly how the procedure is performed and what you can expect to happen the day you go in for the shots. (That is unless I think of something we haven't covered yet.)

Next: Part Five: The Procedure

NEXT >


Table of Contents for this series:

  1. Epidural Steroid Injections
  2. Are You a Candidate?
  3. The Difference Between Corticosteroids and Anabolic Steroids
  4. Risks and Side Effects
  5. The Procedure

Supplemental Article: Sciatica and the Saline Story

About the Author

Dean Moyer is the author of the books, Rebuild Your Back, Rebuild Your Neck and The Pain Relief Manual. Copies of his books are available exclusively through this website. Read more...

Rebuild Your Back
Rebuild Your Back
Second Edition
Rebuild Your Neck
Rebuild Your Neck
The Pain Relief Manual
The Pain Relief Manual

References:

1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.



Last updated: Feb 10, 2009