Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
Epidural Steroid Injection
Epidural steroid injections (ESI’s) have been found to be very effective in relieving pain. A steroid is a potent,
anti-inflammatory agent that, when injected into the epidural space surrounding the spinal nerves, may reduce the
swelling of these nerves and the pain which often accompanies a back or neck disorder. It should ideally be
performed for radiculopathy (pinched nerve causing pain to shoot down an arm or a leg) or spinal stenosis (a
combination of arthritis, thick ligaments, and disc bulges squeezing the nerves inside the spine and causing
symptoms of increased back and leg pain while walking, nearly completely relieved after sitting for a few
minutes). Epidural injection should not be performed for spinal arthritis or disc bulges as the results are no better
than 50/50 in relieving the pain for more than a few weeks.
Preparing For Your Epidural Steroid Injection
Notify your physician if you regularly take a blood-thinning medication including aspirin, Plavix, or Coumadin, or
if you develop a fever, an infection on any part of your body, or flu symptoms before your scheduled appointment.
What To Expect
When you arrive at the Pain Clinic, a nurse will escort you to an examining room and ask you to disrobe and put
on a hospital gown. The nurse will then ask several medical history questions to make certain you have no allergies
to any of the medications being used. You will be placed face down on an X-ray table and then the injection site
will be scrubbed with iodine, alcohol, or other agents depending on allergies. The doctor will then inject a local
anesthetic into the appropriate area, which may cause momentary discomfort and a slight burning sensation. After
the area is numb, the doctor will insert a needle through the skin into the epidural space and inject the steroid. You
will feel pressure while the doctor injects the steroid. The nurse will then place a band-aid on the injection site and
check your blood pressure and pulse. Some patients experience feelings of anxiety while undergoing this
procedure. If you experience such feelings, your blood pressure and pulse may become slightly increased. If so, the
nurse will continue to monitor you for approximately 30 minutes while you sit or lie down. This short period of
rest will help your blood pressure and pulse return to normal. The epidural steroid injection procedure takes
approximately 5 to 15 minutes to complete.
After Your Injection
You may resume your normal activities immediately following the procedure. You may drive yourself home,
although some patients are more comfortable allowing someone else to do so. You may experience some soreness
at the injection site for the first 24 hours after receiving your epidural steroid injection. If so, applying ice will help
reduce your discomfort. If you are currently undergoing physical therapy, you can resume your stretching and
strengthening exercises immediately after receiving your injection, unless your physician or physical therapist
advises you otherwise. The day after you receive your injection, you may remove the small adhesive bandage and
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com
Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
wash the injection site with soap and water. If you experience a headache, redness, swelling, tenderness, or warmth
at the injection site, notify your physician.
Commonly Asked Questions
Will I receive more than one epidural steroid injection? One epidural steroid injection provides long-lasting pain
relief for many patients, especially those who are undergoing physical therapy and are diligent about observing
good posture. It can take 3-5 days before you begin to respond to the steroid. If you experience complete pain
relief after one injection, you will not undergo additional injections. Pain relief can last for many months. If you do
not respond to the first injection, a second injection will be administered about two weeks after your first injection.
If there is no improvement after two injections, your physician may suggest alternative treatments. Of particular
note is the SERIES OF 3. This is an outdated philosophy from days before the use of Xray guidance and adequate
research. It is my belief that any physician who routinely performs a series of epidurals is thinking more about the
business than the patient. Recent literature proves this to be the case.
http://www.worklossdatainstitute.verioiponly.com/odgtwc/low_back_files/novak.pdf
Epidural injections can be performed by different entry points into the spine. The least useful is a caudal injection.
A needle is placed into the base of the spine just above the tailbone. Unless a catheter is used, the medication is
spread out over the sacrum and only some of it gets to the site of pathology (pain generator). Another method of
entering the spine for epidural is interlaminar technique. This is the classic technique where a needle goes through
the skin into the midline of the back and between the vertebrae. This technique is preferred for the neck due to
safety concerns, but uses a larger needle. The preferred technique for the lower back is the transforaminal
approach. A smaller needle is inserted just to the side of the spine and is advanced into a foramen (the opening
where the nerves exit the spine to go down the leg). It allows the medication to get closer to the disc and nerve
root and is thought to do a better job of relieving pain.
All spinal procedures must be performed with live Xray guidance (fluoroscopy) and injected contrast to ensure the
medication is going to the appropriate location. Failure to use these readily available methods for pain procedures
places patients at unnecessary risk and reduces accuracy of needle placement significantly. Epidurals for labor and
delivery and surgery are markedly different than epidurals for pain.
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com
Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com
Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com
Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com
Medical Associates of North Georgia
Pain Clinic Director:
Steven M. Lobel, MD
Board Certified:
PM&R and Pain Medicine
Program Director:
Medical Associates
Pain Medicine Fellowship
Specializing in Interventional Spine and Sports Medicine
320 Hospital Road
Canton Georgia 30114
T: 770 479 5535 F: 770 479 8821
www.stevenlobel.com