Pain Management

Epidural steroid injections (ESIs) have become an important part of non-surgical management of spine pain. ESIs work by delivering steroids directly to inflamed, pain-generating spine areas, decreasing the inflammation that may be causing the pain. These treatments often work because medication is delivered directly to the inflamed area. Similar procedures are available to treat pain related to nerve roots, facet and sacroiliac joints.

Treating pain at its source.

We understand the impact chronic pain can have on even the simplest day-to-day activities. We’re proud to provide pain management options that offer relief for our patients without surgery. Our team of neuroradiologists performs hundreds of pain management procedures annually, including ESIs, nerve root, facet and sacroiliac joint injections. This year-round experience, coupled with the latest fluoroscopic equipment for imaging guidance, makes Eastern Radiologists the leading choice for patients with back pain, radiculopathy, or nerve root injury. Plus, patients appreciate the added convenience of the short walk from our parking lot to our outpatient office at Doctors Park in Greenville. We take pain management seriously and look forward to helping you.

Frequently Asked Questions

What are the risks?

As with all invasive medical procedures, there are risks associated with ESIs. However, they are rare:

  • Minor infections occur in 1% - 2% of patients
  • Bleeding is uncommon
  • While extremely rare, nerve damage can occur directly from the needle, infection or bleeding
  • Dural puncture occurs in 0.5% of patients. This may cause a spinal headache that usually improves within a few days
  • Paralysis is not a risk

Temporary leg weakness, involving one or both sides, may result from the effects of an anesthetic medication if administered for low back ESIs. The risk is greater if a dural puncture occurs, or if you’ve had prior surgery. If you have had prior surgery, you may also notice delayed lower extremity numbness or weakness.

There are very rare side effects from the steroid medication:

  • Temporary decrease in resistance to fight infection
  • High blood sugar, particularly if you have diabetes
  • Stomach ulcers
  • Severe arthritis of the hips
  • Increased blood pressure
  • Transient flushing
  • Increased appetite

When is an ESI typically recommended?

In general, ESIs are used to help provide pain relief. Several common conditions can cause severe acute or chronic spine pain include disc herniation, degenerative disc disease and spinal stenosis. For these and other conditions that can cause pain, an ESI is an effective non-surgical treatment option.

How is an ESI procedure done?

An ESI usually takes 15 – 30 minutes. You will lie flat on your stomach on a X-ray table. Using fluoroscopy, the physician guides a needle through your skin toward the epidural space, confirms its location by injection of iodinated contrast, and then injects the steroid. Afterwards, you will be monitored for 15 – 20 minutes and then allowed to go home. Sedation is available if you are anxious or uncomfortable, but you must have someone to drive you home. You should rest the remainder of the day after the injection. You can resume activities the next day, but you must still obey any restrictions that your spine doctors have given.

What are the benefits?

The main benefit of the ESI series is a reduction in pain. ESIs relieve pain for 50-75% of patients. For maximum benefit, ESIs are usually given in a series of three injections, each separated by two or three weeks. You can make your next appointment before going home. If you do not get pain relief from the first injection, further injections may still help. Also, other types of injections, such as nerve root or facet blocks, may be tried depending on your pain and the way your spine looks on MRI, CT or radiographs.

How frequently can ESIs be performed?

There is no research that gives a definite answer to this question. It is reasonable to perform up to three injections per series, with series separated by at least three months. A series of three injections is not always necessary. If one or two injections lessen your spine pain, some physicians may prefer to save the third injection for any recurrence of spine pain. Most physicians believe that a series of three injections provides the best chance for lasting relief.

Schedule an appointment.

Please have your doctor schedule your appointment for this service. If you have questions about your appointment or need to reschedule call 252.752.5000. This service is offered at the following locations:

Prepare for your appointment.

*Please review the Epidural Steroid Injection (ESI) questionnaire and patient instructions link prior to your appointment.

Notify the radiologist and nurse if you are allergic to iodinated contrast or steroids. Please remain on a clear liquid diet starting four hours before procedure. If you have a spine MRI and/or CT, please bring these with you to your appointment. Lastly, the effects of sedation will prohibit you from driving after the procedure, so please arrange for a ride home.

ESIs should not be performed if you have an infection or bleeding problem, or if you are pregnant (since X-rays are used). Occasionally, an MRI scan may be needed prior to the ESI to rule out certain conditions. Injections may be done, but with extreme caution, for patients with allergies to the injected solution, serious medical problems (such as congestive heart failure or uncontrolled diabetes), and those who are taking aspirin or other blood thinning drugs such as Ticlid or Plavix.