Epidural steroids for herniated lumbar disc + sciatica?
August 29, 2014 3:03 PM   Subscribe

YANMD, yes. The more I investigate this, the more I can't seem to get a straight answer.

I've had an MRI that clearly shows a herniated lumbar disc, but this doesn't necessarily = "you must get an injection", although my neurologist and chiropractor both believe it may help. That is, neither of them are going "yes, you should definitely do this."

I've already done 3+ months of pt, some acupuncture, massage and attempted changing of any physical situation (ergo, car seat, standing posture etc), but it's been slowly getting worse. This week, I went to see this highly recommended new pt guy who has had me doing a crazy # of those yoga-style cobra press-ups per day, and that does seem to alleviate it somewhat as my day progresses and I do more of them - but each morning I revert back to where I was the previous morning. Granted I know that this won't magically work overnight, but still. All this being said, my question remains - is it worth risking having somebody jab me in my spine to reduce the inflammation of the nerve root? My chiropractor (who I regard fairly highly), thinks that by continuing to put off the injection, I'm just putting off letting myself genuinely feel better. Statistics say the procedure is pretty safe, but er... it's still a 5% chance of something evil happening from getting poked in the spine.

What say you, fellow herniated disc people who have had sciatica as a result? Thanks muchly.
posted by bitterkitten to Health & Fitness (20 answers total) 4 users marked this as a favorite
In your situation I got the shot, and it was life changing. Sadly, for me, the effects only lasted about two weeks. You can get up to three, I think, and I may get the other two soon. But at the same time, I got a new job in a new state, my commute changed radically, and I need to switch doctors as a result - it's a lot of work I haven't done yet.

The shot wasn't particularly painful except for one tiny moment, and the effects were immediate.
posted by kythuen at 3:15 PM on August 29, 2014 [1 favorite]

I have two herniated discs in my neck. No nerve pain but a hell of a lot of muscle and joint pain.

My orthopeidst, neurologist, physical therapist and the guy who does the injections says they don't work for everyone and it's hard to predict who will benefit, but they do help a lot of people. I believe that they're considered very safe, assuming you go to a good doctor.

I had two injections done. One was an epidural which I believe is technically more risky. It gave me about 2 weeks' relief. I had another in the joints and that didn't provide relief. However I don't regret doing them as I think they were a practical course of treatment.
posted by radioamy at 3:39 PM on August 29, 2014

My husband had a ruptured disc and after the injection went from writhing on the orthopedist's exam room floor to being able to sit and walk like a human. The injection had both a steroid to reduce inflammation and an anesthetic, which slowly wore off over a day or so. That provided relief that gradually improved over about 24 hours, and he had much, much less pain for the next few weeks while he healed naturally. Part of the purpose of the steroid is to reduce inflammation so healing can occur. Inflammation itself can prevent or delay healing. It sounds like your situation is more chronic than acute, and of course each person has their own response.
posted by citygirl at 4:00 PM on August 29, 2014

Anecdotally, I am in a job where I read medical records of many people's lumbar spine treatments pretty much constantly. I have read records of lumbar epidural steroid injections approximately a million times over the past eight years and I've never seen a single one with complications (though they don't always work).
posted by amro at 4:11 PM on August 29, 2014 [6 favorites]

Had the injection done in my lower back in October. It provided some (not full) relief for 3 or 4 weeks. By December it was actually worse than before. I'm now almost completely sedentary and in pain all the time. I should probably go back to the doctor but it just seems hopeless.
posted by falldownpaul at 4:46 PM on August 29, 2014

Falldownpaul, next step if ESIs fail is usually surgery. Not fun but not hopeless.
posted by amro at 5:01 PM on August 29, 2014 [2 favorites]

Last Sept. I had an L3-L4 disc bulge that caused sciatic pain so intense I couldn't stay upright (sitting or standing) for more than a few minutes. I had two injections. The first one took about a week to start working, and took my pain down about 30%-40%. The second, 2.5 weeks after the first, took the pain most of the rest of the way down. Between those, PT and acupuncture, I was mobile again after about 5 weeks, and recovered enough to return to work after another 3. I was essentially full recovered by January, cycling/gym by March, and I started running again in June.

I was terrified of the injection, because hey, needle in back, but both times it was done with a flouroscope, and they went in very slowly. Probably 30 seconds to get the needle in place, and another 60-90 seconds to deliver the steroids.

Full disclosure, the first injection hurt more than anything else I've ever experienced. The doctor administering the shot warned me that it was likely to hurt the same way as the sciatic pain, since the medicine was being administered on top of the nerve and because my damage was so bad ("marked encroachment" was the term from the MRI). The pain was exactly the same, intense burning down my leg, but only lasted as long as the steroid was being administered. The second shot caused no pain at all, so I think the level of pain is related to the level of damage.

I'd be happy to talk about it more with you, memail me if you want.
posted by Gorgik at 5:54 PM on August 29, 2014

Just to follow up, my experience was very different than Gorgik's in terms of pain because I was sedated. I think they used some medium level of sedation where you're not totally knocked out (the way you would be if they were operating) but I'm pretty sensitive to sedation so I don't remember anything. Definitely talk to the doctor about the type of anesthesia they will use and if the injection will cause any discomfort.
posted by radioamy at 6:07 PM on August 29, 2014

This happened to me, only my disks ruptured. I dicked around with PT and a Chiropractor for WAY too long.

I had to have two injections of cortisone, three weeks apart. That was 18 years ago. I've never had another issue since. (Except that I can now predict rain.)

It doesn't hurt. I will say, cortisone makes you crave sugar like a fiend, so don't do it on Halloween and then eat a whole bowl of Snickers. Ask me how I know.

Good luck to you. It feels SO GOOD when the pain stops.
posted by Ruthless Bunny at 6:27 PM on August 29, 2014 [1 favorite]

I've suffered from a herniated lower back disk for years, now. Usually, it would flare up every six months, or so, usually due to stress or a physical strain. This was debilitating pain, every time; no walking, standing, sitting, or lying down for me. Opiates, muscle relaxers, and huge ibuprofen doses helped, but recovery usually took about a week.

Then, my most recent time, the doctor suggested the above plus a short course of oral steroids. Prednisone, I believe. Just a couple of days worth, but it made all the difference; knocked down the swelling almost immediately, and cut the recovery time in half.

Perhaps your professionals have already discounted this as an option, and a shot is their preferred approach at this point. But if it hasn't come up, and you aren't comfortable with a shot, this might be a good alternative to suggest.

Thankfully, doing some serious core PT has kept me (major) flare free for over a year. But if it makes a comeback, I'll definitely do the steroids again.
posted by credible hulk at 6:43 PM on August 29, 2014

I had several herniated and ruptured discs in my low back (car accident), with severe sciatica. After 2+ years of PT, painkillers, chiro, etc, I was finally sent for an epidural. The first one helped for a couple of weeks, but when the pain returned, it seemed worse than before. The second epidural didn't help me at all. I was considering a third, but the anaesthesiologist felt that if I had already done 2 injections in 4 months without significant relief, then it was unlikely that a 3rd injection would help much. I was advised to have surgery. I decided to try acupuncture instead, and that worked miracles for me.

In researching my options (this was many years ago), it seemed like the chance of a complication from the epidurals was fairly low; the most likely risk seemed to be that it simply might not work. My understanding is that when it works, it is AWESOME... But it just doesn't stop the pain for a good chunk of the population. I found the epidurals to be quite painful, but did not have any complications following the injections.

Good luck to you - I have been in your shoes, and they are very uncomfortable shoes indeed.
posted by JubileeRubaloo at 7:32 PM on August 29, 2014 [1 favorite]

I have had the spinal injections both in my neck and my lower spine. They worked to temporarily relieve the pain although it took until the second one for the neck. I did loads of pt. I am not a go to a chiropractor person but for those who appreciate them, that is good. I ended up after a while getting a fusion in my neck and I had 3 operations that culminated in the third being a fusion of L4-L5. I have been pain free ever since. I am playing ice hockey, basketball and golf. I am in my younger 50s.

If it were me, I would get the injections, continue with PT/yoga and strengthen my core. I would try this for several cycles or until the pain is unbearable. Then, I would heal with steel and get operated on.
posted by 724A at 8:18 PM on August 29, 2014 [1 favorite]

I came to say what amro said, I didn't believe that a 5% complication rate was possible with such a common and safe procedure.

Then I actually went and reviewed the literature and found a meta-analysis describing the complication rate for these procedures, and actually the rates they're quoting for complications are even up to 10-15%, BUT - they are counting as "complications" even the most minor of effects that occurred during or after the procedure. When I think complications of epidural injections, I'm thinking really rare stuff like nerve damage or something. What they're talking about are transient symptoms like headaches, increased neck or back pain, facial flushing, and people feeling faint or fainting (which is a complication of any procedure that involves a needle, generally… it is called a vasovagal reaction). So - just wanted to make sure you are clear on that, because I wouldn't refer to these types of complications as 'evil'.

In case you were curious, the meta-analysis concluded that there is strong evidence that such injections provide short-term relief from pain, limited evidence that they provide long-term relief.
posted by treehorn+bunny at 9:06 PM on August 29, 2014

I had it in my neck twice and was initially terrified as well but oh my god it was so worth it. SO WORTH IT. I can actually hold things in my hands again instead of using fucking adhesive velcro strips and winter gloves for literally everything from my toothbrush to my teacups.

I will be getting the injection for my herniated L5 sometime next year and I am pretty excited for it, the relief is so astonishing. I went home and cried like a fat gassy baby after the first one because I'd been living with the pain for so long that I forgot what if felt like to feel good.
posted by elizardbits at 9:33 PM on August 29, 2014

The research on steroid injections is they help some in the short term, but there is no evidence they help in the long term. Repeated steroid injections eventually can lead to bone breakdown, hence there is a recommended limit per year. So there are negative sides to steroid injections (risk of adverse effect for every injection, risk of long term use if you keep going back for more), but there are no positive long term benefits to the injections.

The problem with getting anecdotes on this kind of thing from the internet is, someone can easily feel that the injection they had changed their life! However since it's only one person, there is no way to know if that person's pain would have just gone away on its own anyway. That's why we do studies and meta-analysises.

I think when you have chronic pain, you feel willing to try anything, but there is truly no evidence to support steroid injections for long term pain relief. (On the other hand, the risk for a one time shot is quite low, so many people say, Why Not - which is an understandable perspective!) I frankly think these injections are an example of a common medical practice that is not evidence based, but rather emotionally based - a desire to do something even when everyone knows it doesn't make a lasting difference. Another interpretation: it is a procedure you can bill for that can be done in doctors offices, so even if happening on an unconscious level on the part of the provider, the decision to recommend the treatment does increase income for the provider (depending on how they bill/get reimbursed).
posted by latkes at 9:56 PM on August 29, 2014

Another anecdote from a similar situation. About 7 years ago I had a sudden back pain while working in the yard, and it was unbearable. First thing (which I will never do again) was the chiropractor. This is dramatically different than PT, certainly. Then into the regular physician, onto a specialist who viewed invasive procedures as a last resort. Herniated disc was causing constant pain, foot drop on one side, and sciatica. It was bulging to an extent that the doctor told me flat out that the steroid injection would be her next step, but might very well require surgery down the road if there was no improvement. And that she wanted to avoid that if at all possible.

The procedure was painless. A pinch to numb the area, laying on the x-ray table while the did the shot into my lower spine. Completely awake, done and over in less than ten minutes on the table. There was noticeable relief over the next few days, but it wasn't complete and immediate like some have stated in their cases. For me it was more of a kick start that seemed to initiate improvement over the next three months, including PT exercises.

Recently, I had another bout of back issues. The symptoms came back after straining my back physically (that's right, stereotypical moving a heavy washing machine). I was facing the same issues, had the same sensations (though not the longer-term effects like foot drop this time around). Since it had been so long, my specialist had to admit me as a "new patient" and I was on a two plus month waiting list for an appointment. During that time, I tried all the intermediate steps - constant ibuprofen, and the old back exercises.

Somehow I stumbled across a recommendation for the McKenzie Method of back treatment. In a book I purchased on Amazon, it went through very simple and straightforward physical therapy methods to help with back pain. And dammit, it really worked for me. I went from barely able to do the first step in severe pain to essentially back to normal over the next month or two. I was completely expecting to need another steroid shot, if not more invasive treatment. But by the time the doctors office called to confirm my appointment I was able to cancel without hesitation (and without pain).

I know my back will always be susceptible to injury, and I have to be careful about that. I do know that the steroid shot helped me on the road to recovery. I know that the specific exercises I did recently helped as well. I can't say just the PT would do it alone, nor do I think the steroid would alone either. From my experience, I wouldn't hesitate to get the shot, and continue on your current PT afterward (or find another type of PT treatment).
posted by shinynewnick at 12:16 AM on August 30, 2014 [1 favorite]

Another experience to throw into the pile. I had an epidural for a herniated disc in the lumbar region back in 2007. They messed it up - search on "epidural wet tap". Three days after the procedure I tried to get up and couldn't walk (had no pain relief in the meantime). Ended up in Accident & Emergency, spent 5 days in hospital with neurologists, etc scratching their heads, went through a very painful lumbar puncture because they suspected viral meningitis from the procedure (it wasn't - thankfully) and was then off work for over a year recovering - with another 5 day hospital stay a few months later because of utterly overwhelming pain.

I've finally, 7 years later, been diagnosed with Fibromyalgia bought on by the shock to the system from the botched procedure - so it does go wrong and there can be consequences. I was told 1 in a 1000 and knew that risk going in. It's kinda turned my life upside down. I'd still go for an epidural again rather than have an operation on my back.

Everyone I know who has had back surgery has ended up having more back surgery to deal with the previous back surgery. It seems once you start down that road... anecdata, etc. but I believe that if you can manage the pain without surgical intervention that's the way to go. I can't always manage it and I'm still learning new stuff but surgery... not going to happen.
posted by IncognitoErgoSum at 12:17 AM on August 30, 2014

I had an epidural steroid injection about 13 years ago, in my thirties, for herniated discs in my cervical spine. Before it I had pain, tingling, and weakness in my arm that was worse when I laid down; I'd had to sleep sitting up for a few months. OTC drugs, physical therapy, and acupuncture hadn't resolved it. The injection was a last try before resorting to surgery.

For me, the most painful part of the surgery was having to lie flat on the table -- that was the worst position for my nerve pain. I did feel the injection "light up" the same nerve for a moment, but it wasn't any more painful.

Afterwards, the symptoms were gone. I think I remember it took two or three days? The symptoms have never returned. I always had the impression that that surprised my doctor.

Good luck with whatever you decide; I hope you get relief.
posted by daisyace at 6:31 AM on August 30, 2014

I got the shot, and it made my pain worse. I don't know how, but I remember feeling a zing during the procedure that didn't feel quite right. My theory is that the herniation just got nudged or something during the procedure. I don't know. Ultimately, I ended up with surgery that did help, immediately.
posted by pyjammy at 12:10 PM on August 31, 2014

(To clarify, I also had a severely herniated lumbar disc that caused major sciatica.)
posted by pyjammy at 12:14 PM on August 31, 2014

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