Epidural Steroid Injection (ESI): A Patient's Perspective
If you are a patient experiencing back pain, and have tried numerous treatment methods, only to find that they help just a little, or not as much as you would like, then maybe your next step is an epidural steroid injection (ESI).
I've been dealing with a herniated disc for the last four years or so, and have tried everything from physical therapy, chiropractic, pain medicine, acupuncture, rest, ice, heat, ointments and many other things. So after visiting a back specialist, who thankfully told me I was not quite a candidate for back surgery yet, he suggested the minimally invasive epidural steroid injection. If this has been recommended to you, and you have done an Internet search on the topic, you likely will be shown hundreds or even thousands of links to websites from surgery or radiology centers that perform several of these procedures daily. But a patient's perspective isn't as accessible, so here I am to tell you about my experience.
First of all, I hate needles, though not to the point where I get sick before any type of injection or blood work. However, this was different. We're talking about a long needle that goes directly into your spine and then serves as a vehicle for something usually akin to cortisone, which then shrinks inflammation surrounding the disc or area in question.
I was told by a friend who works at this particular facility that he sees 20-30 of these procedures a day (yikes!), and that it's usually pretty painless as a whole. Still, I know how much pain I'm in and I was scared of someone sticking a long needle directly in there.
So, after arriving and filling out mountains of paperwork about medical history (if you take blood thinners of any kind, you have to stop taking them for a few days prior to your injection), they took me in the back and got my vital signs. My blood pressure is usually normal, but it was a bit high due to my anxiety.
Then a doctor came in and explained the procedure, also answering every dumb question I had, such as "Are you SURE I won't feel the big needle?" He assured me that I wouldn't and that if I did, that I could let him know and they would give me more numbing solution, a.k.a. lidocaine.
So I went in, and I'm not sure if this is typical of every center that performs these, but I didn't even have to wear some uncomfortable hospital gown or anything. Simply loosen your pants, and jump on the table. That was encouraging.
Then they prep you by washing your skin a bit, and the doctor comes in. Now, I should mention that this is done on an X-ray table, so that the doctor can see where he is going with the needle. Unfortunately, my doctor came in and informed me that he had just gotten off the phone with my back specialist, who clarified that he wanted an ESI that gets closer to the S1 nerve, because that's what was causing the bulk of my pain. Yikes, I said, and I really said that. I had acupuncture a few years ago and I distinctly remember almost jumping off the table from some of those needles touching on nerves. Still, this was supposed to be different.
They numbed me with the lidocaine, which felt like a little bee sting, and quite honestly didn't hurt for more than 2 seconds. After I started to feel numb, the doctor put the big needle in, telling me what he was doing the whole time. I'm not sure if that's good or not, but I was still fearing that jolt I might feel from hitting the nerve. I did feel it a bit, but it didn't hurt all that much...still, he didn't want me feeling anything and gave me more lidocaine. Then, finally I did feel a very slight electric type shock, but I mean slight. He was there, and poured the cortisone in...which made me feel pressure in my lower back and down my left leg, pretty much where most of my pain is.
Then, and it happened so quickly, the needle was out. I had visions of having trouble walking, but I didn't at all. They took me into another room and got my blood pressure again, which was still sky high, and I knew it would be. But I was relieved that this was over.
Then what? Well, they recommend that you have a driver to take you home in case you have lingering numbness in your leg(s). Then you should rest for the remainder of the day, and resume normal activities the day after that. You will be sore, as if you had a tetanus shot, for a few days, and then by the third or fourth day the cortisone should start to fully affect the area. I have to say that in my case, it took more like five or six days to feel improvement, and even then we're talking maybe 15%.
I've read, and been told, that it sometimes takes 2-3 injections to get the most benefit, so I'm going to probably try it again in a few weeks and see how that works. At least this time, I won't be as scared or anxious as I was the first time, because that unknown factor won't be there.
For those of you who have been recommended this procedure and are dreading it, I can tell you that there is really nothing to be afraid of. The whole thing is almost completely painless, and the worst part might be the soreness you'll feel afterward. Plus, the actual procedure takes about 10 minutes.
I'll report back more after my second injection, and meanwhile I hope this hub helps many of you and/or alleviates your fears!