Pain Management Procedures - Epidural Steroid Treatment and Side Effects

Pain Management Procedure - Caudal Epidural Steroid Injection

This pain management procedure is used to relieve the lower back and radiating leg pain. Steroids may reduce swelling and inflammation caused by stenosis, radiculopathy, sciatica, and herniated discs.

Before performing caudal steroid injection, the pain management physician places a pillow underneath the stomach and back arch for comfort. The doctor uses a fluoroscope to find the small opening at the base of the sacrum.

How a caudal epidural spinal injection is performed?

Local anesthetic is used to numb the skin and tissue to the surface of the sacral hiatus. After the needle is carefully placed in the area, a contrast solution is used to help doctors to see the painful areas using the fluoroscope. Then, a mixture of anesthetic and antiinflammatory drugs is injected into the epidural space, infiltrating the painful area with medication. The needle is removed and a small bandage is used to cover the small area of the wound.

Most patients have relief after one or two caudal epidural steroid injections, but it may be necessary to repeat the procedure several times to get the maximum benefit from medication.

Common side effects may include allergic reaction, bacterial infection, bleeding in rare cases sometimes. Side effects of steroids are face, eyes, arms, and leg swelling, increase of sugar level in diabetic patients.

The patient should tell their doctors about pregnancy or if he/she takes blood-thinning medications.

Celiac Plexus Block

This pain management procedure is used to diagnose and relieve abdominal pain caused by cancer or pancreatitis. The injection blocks the nerves serving the abdomen. The intravenous anesthetic can be used to relax the patient.

How a celiac plexus block is performed?

Local anesthetic is used to numb the skin and tissues to the celiac plexus. A doctor uses a fluoroscope and contrast dye to confirm correct placement of the needle tip. Numbing medicine is injected around the nerves to block pain signals from reaching the brain.

The first shot could be a test. If pain relief occurs, permanent block could be used. Most patients have immediate pain relief after the injection.

Common side effects are bacterial infection, allergic reaction, bleeding in seldom cases. Steroids side effects are the face, arms, eyes, and leg swelling. Some diabetic patients experience increase in their sugar level.

Sacroiliac joint
Sacroiliac joint

Steroid injection into the Sacroiliac Joint

This procedure is done to eliminate pain caused by sacroiliac joint arthritis. Sacroiliac joint is a joint that connects the spine and pelvic bone. Steroid medication can reduce swelling and inflammation. During this procedure, the patient lies face down with a soft pillow under the stomach for better comfort and to help relax the spine.

How a sacroiliac joint injection is performed?

A local anesthetic is administered at the site of injection, which numbs all tissues to the sacroiliac joint. Then, a steroid-anesthetic mixture is injected into the painful area.

Possible side effects are comparable to the effects of a single injection: Patients may have allergic reactions, bacterial infection or bleeding that rarely happens.

How a facet joint injection is performed?

This injection is given to treat the facet joints, which cause back pain, neck pain, and inflammation. Each vertebra in the spine is connected with two facet joints. A local anesthetic numbs the skin and facet joint tissue.

Pain management physicians use fluoroscopy with contrast and resolution to confirm the correct placement of the needle tip and apply their knowledge of bony landmarks. A mixture of anesthetic and anti-inflammatory steroid medication is injected into the joint. Sometimes two or more injections may be needed. If the patient feels pain relief after the injection, this confirms that the facet joint is the source of the pain.

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27 comments

kunika 7 years ago

Good piece of work.


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

Thanks a lot Kunika.


Veronica Allen profile image

Veronica Allen 7 years ago from Georgia

This sounds similar to an epidural a woman gets before giving birth except for the fact that these contain steroids and have to be given on a far more frequent basis than the one time injection given a laboring woman. Thanks for listing both the benefits and the side effects. Great info!


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

Yes Veronica you got it right. I also received a local anesthesia injection similar to these epidural steroid injections when I underwent my kidney stone removal surgery in March 2005. I remember that kidney stone was really painful but after its removal with extracorporeal shock wave lithotripsy, I felt really really better. Thanks to RG Stone Research Institute located in New Delhi, India. They helped me a lot and took proper care of my stone.


sarovai profile image

sarovai 7 years ago

New information for me and I got some knowledge about the steroid injections. Thank u soni2006.


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

It's my pleasure sarovai. Thanks a lot for reading this hub in such a detail. Were you able to understand the information properly or it was tough?


rmcrayne profile image

rmcrayne 7 years ago from San Antonio Texas

Really good hub. We'll talk specifics by email.


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

It's my pleasure friend. Waiting for your mail.


ethel smith profile image

ethel smith 7 years ago from Kingston-Upon-Hull

That was really interesting but too much information would make me more nervous :)


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

I always like the fun-loving nature of yours Ethel. You are really humorous and that's a plus point to your personality.


Money Glitch profile image

Money Glitch 7 years ago from Texas

Very interesting and informative hub, I love the detailed pictures and the pros and cons of having it done . I have heard of steroids being used for pain management, but I must admit I had never thought about it being injected into the spine. Thanks for sharing...


Jjustice profile image

Jjustice 7 years ago

Soni, I have had this procedure preformed several times over the last few years for an L5-S1 herniated disk (7mm)and always have had good results. Recently, the last series I had when it flared up again has not produced success. The Dr. states that I may have reached the point where this will not work anymore. Unfortunately I am not a good candidate for suregery as the amount of time and metal needed to repair mine may cause complications and has a low percentage chance of success. Do you know of any other pain control methods that I can research?


soni2006 profile image

soni2006 7 years ago from New Delhi, India Author

Sorry for the late response to your question Jjustice.

You asked, "Do you know of any other pain control methods that I can research?"

My answer: I think the best guide is your doctor. If he/she has not got any other options available, you can go ahead with searching for another prominent orthopedic spine surgery specialist in your area.


sciatica & disc center 6 years ago

Hi Soni,

Thank you for your comment and info added to our page. The info you have is very thorough and I can see the value but I worry that some of the advertisements and links may go against the message of our procedures.

What do you think?


soni2006 profile image

soni2006 6 years ago from New Delhi, India Author

Thank you so much for your appreciation and feedback Sciatica and Disc Center. Please let me know what types of ads and links are going against the message of your procedures and I will definitely do something for that.


sheila 6 years ago

I had my fourth epidural last april somethings different on yhis one, I have anxixity and i cant sleep more than two hours at a time and I cant get out of pain. The one spot he went into is in pain constanatly, it's a big lump close to my spine and it hurts worse than a charlie horse, dont know what to do.. Also after the last epi, I couldnt breath and felt no relief and now pain goes from epi site up left side of my back, pain uncontrollable, any advice??? PLEASE


soni2006 profile image

soni2006 6 years ago from New Delhi, India Author

If you are able to get help with the epidural injection, then I would advice you to try yoga exercises for back pain relief and treatment but you need to be consistent with them. Here is the link to a brilliant article I found via google: http://www.solveyourproblem.com/back-pain-relief/e...

The exercises are easy to do but again you need to be consistent to solve your problem.


Steroids uk 6 years ago

my wife ahd an epi for our son's birth i was shocked to see that they left the plastic tube in afterwards and nearly pulled it off by mistake.


soni2006 profile image

soni2006 6 years ago from New Delhi, India Author

Oh my God, that's a terrible thing. This is a fine example of a careless error made by pain management people.


DePuy Pinnacle Lawsuit 5 years ago

Would epidural shots be effective on major surgeries such as hip implants?

I am thinking of having a hip surgery but have been anxious about it after learning of some reports online about a DePuy Pinnacle lawsuit.


soni2006 profile image

soni2006 5 years ago from New Delhi, India Author

It is basically not advisable to have epidural shots after having a major surgery such as hip implants as there will be very little effect. Also, epidurals become useless where surgery is the last resort for patients, as surgery is chosen when the patient fails to respond to conservative measures and if people start having problems with their implants, as is the case mentioned above, then that would be a worrisome situation both for surgeons and the patients.


Nuray 4 years ago

I had caudal epidural a mont ago I feel pressure in my eyes is this normal


Bogey 4 years ago

I had epidural injections in my lumbar spine in July 2007. After having a series of six injections my back pain was under control by December 2007, however, I noticed a pain in the left side of my rear. The pain continued to get worse and then I started feeling a sharp pain at night in my left goring area. In May 2008, my Doctor had me go for an MRI and it showed I developed Avascular Nercrosis AVN in my left hip. As a result I had to have a Core Decompression Surgery to try and save my left Femur from dying. Since the surgery I have been in pain on a daily basis and required spinal fusion from my L2 to S1 in March 2010. I have had every test to find the cause of my AVN and the only known cause is the Epidural Steroid injections. To anyone in back pain I strongly suggest you use extreme caution as I'm in far worse condition as a result of the injections and I required back surgery anyways. I realize when your in back pain you will try anything but Epidural Injection side effects are not worth it. Now my new pain management doctor has me on a patch by Butrans to control the pain. You place the patch on for 7 days and it reduces pain levels from extreme to moderate. Good luck to all and use caution with anything to do with Steroids.


mick 4 years ago

I have severe back pain at night lying down. I have had xrays and MRI all negative. The Dr's say my back muscles are in spasm and have recommended the epidural injection. Will this injection stop the muscle spasms?


bobsmate 4 years ago

I HAD A CAUDEL INJ LAST WEEK.. NEVER EVER AGAIN. I HAVE HAD 2 SPINAL FUSIONS IN 3 YRS. THEN FELL AND INJURY TO MY SI JOINT. I AM IN CONSTANT PAIN. DR SAID I HAVE A LOT OF SCAR TISSUE TO GET THROUGH TO PUT MEDS IN BACK. I AM AT MY WITS END ON WHAT TO DO NOW. DO NOT WANT MORE SURG. BUT AM NOT LIVING JUST EXISTING. CANT GO SHOPPING OR EVEN GO OUT AND ENJOY MY FAMILY JUST DON'T KNOW WHERE TO TURN. DOES ANY ONE HAVE ANY SUGGESTIONS?


soni2006 profile image

soni2006 4 years ago from New Delhi, India Author

Hello bobsmate, just go through this hub, it might help. I am feeling sorry for your immense pain, May God bless you and take you out of this dilemma. http://hubpages.com/education/core-muscle-stabilit...


Tracey 4 years ago

I have had three epidurals in the this year to treat my back pain and siatica.This time my cheeks are noticely puffy.Some one tell me this won't last long!

Thankx. Mrs Blowfish

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