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Epidural for chronic back pain

Published by Bupa's health information team, March 2009.

This factsheet is for people who are considering having an epidural for chronic back pain, or who would like information about it.

Epidural injection for chronic back pain involves injecting local anaesthetic and/or steroids into the epidural space that surrounds the spinal cord.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About epidural for chronic back pain
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from an epidural for chronic back pain
What are the risks?
Further information
Questions and answers
Related topics
Related Bupa products and services
Sources

About epidural for chronic back pain

Epidural injections of steroids and/or local anaesthetic can provide short-term pain relief if you have chronic back pain or sciatica (shooting pain down one or both of your legs). Chronic pain is pain that lasts a long time, sometimes for the rest of your life. The term chronic refers to time, not how serious a condition is.

Local anaesthetic drugs numb the spinal cord nerves instantly and the steroid helps by reducing swelling (inflammation).

It can take up to two weeks for the full benefits of an epidural injection to be felt. The effects of a successful injection can last anything from a few weeks to several months. If the injection helps reduce pain, it can be repeated every two months until the injury or cause of pain has healed.

Steroid injections

The Medicines and Healthcare Products Regulatory Agency (MHRA) hasn't formally licensed the use of steroids for chronic back pain and sciatica. This means the medicine is being used to treat a condition that it isn't licensed for or isn't described in its patient information leaflet. Your doctor can legally prescribe outside the licence or 'off-label', if he or she feels the medicine will be effective for you.

Other uses for epidurals

Epidural injections are also used to provide anaesthesia for surgery, and to control pain after surgery or during childbirth. These types aren't discussed here.

What are the alternatives?

Alternative methods for controlling your back pain include exercise, painkillers, physical manipulation or complementary therapy, such as acupuncture.

Preparing for your procedure

Your doctor will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

Generally, the injection is given in the lower back. Your doctor may use X-rays to help guide the needle into the epidural space.

You must tell your doctor if you could be pregnant. X-rays are safe for adults, but may harm your developing baby, so they aren't usually done during pregnancy. If you're pregnant, your doctor will discuss alternatives to the procedure.

The procedure is usually done as a day case and you may be offered a sedative. A sedative relieves anxiety and helps you to relax.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

If you have diabetes, please tell your doctor before the treatment starts, as it's possible the steroids may affect your blood sugar levels.

About the procedure

The procedure usually takes 10 to 20 minutes.

You may be asked to change into a hospital gown that opens at the back.

You will be asked to lie on an X-ray table face down or on your side with your knees drawn up and chin tucked in. This position helps to open up the space between the bones in your back.

If you're having a sedative, this will be injected into a vein in the back of your hand. You will quickly feel relaxed and drowsy.

Your doctor will carefully select a point to inject by using X-rays and/or feeling for specific bones in the spine and hips.

A small amount of local anaesthetic is injected into your skin. This completely blocks feeling from the skin of your lower back and you will stay awake during the procedure.

Your doctor will insert the epidural needle through your skin and towards the epidural space. At this point, he or she may take X-ray images to help guide the needle into the correct spot. When the needle is in place, local anaesthetic and steroids are injected. Afterwards the needle is taken out and the area covered with a plaster.

You may find the procedure uncomfortable because the needle is being put into an area that is already painful. While the epidural needle is being inserted, it's important that you don't move, as any movement makes positioning the needle more difficult.

Illustration showing where the epidural is positioned
Where the epidural is positioned

What to expect afterwards

Your legs may feel numb or tingly and you may not be able to pass urine straight away but this will pass quickly. Your blood pressure will be monitored for about 30 minutes. After this you will be able to go home when you feel ready.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your back. You may be given a date for a follow-up appointment.

Recovering from an epidural for chronic back pain

If you need them, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Sedatives temporarily affect your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

You should take it easy for 48 hours after the injection. Try to keep active by doing some gentle walking. This can help reduce stiffness and discomfort. Follow your doctor's advice about returning to work.

What are the risks?

An epidural for chronic back pain is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment. Common side-effects are listed here.

Low blood pressure - your blood pressure may fall immediately after the epidural and you may need medicines to control it.
High blood sugar levels - if you have diabetes, you will be carefully monitored after the epidural, but you must also keep checking your sugar levels at home.
Loss of leg strength, muscle spasms and inability to pass urine - this wears off with the anaesthetic.
Back or leg pain - the pain may get worse before it improves.
Difficulty in sleeping - this usually passes after the first night.
Swelling in your hands, feet or joints - this can be caused by fluid retention.

Complications

This is when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of epidural injection for chronic back pain are uncommon, but can include the following.

Headache - the needle can puncture the spinal cord membrane and cause fluid to leak into your spinal cord, resulting in severe headache lasting for up to a week.
Bleeding - the needle can nick a blood vessel and cause blood to leak into your spinal cord. Your doctor will monitor you in hospital.
Infection - you may need antibiotics.
Long-term numbness - you may have patches of numbness lasting up to three months.
If you have an allergic reaction, you will be given medicines to treat it in hospital.
No effect - your back pain may not improve.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

Royal College of Anaesthetists
020 7092 1500
www.rcoa.ac.uk
Back Care
0845 130 2704
www.backpain.org