Epidural Steroid / Anesthetic Injections

I rank this therapy within the realm of last resorts and believe it is treating only the symptoms, not the source of the pain. Of course, if you want to take the risk of someone putting a needle into your spine only millimeters away from the nerves that work your legs or arms, you are welcome to use your discretion. Early in the injury, the steroids will certainly reduce the inflammatory component, and the anesthetic (novocaine like drugs) will immediately eliminate the pain for the few hours that local anesthetic acts. However, the beneficial effect (if received at all) is reported to be not long-lived; and I fear that the steroids well-established propensity to weaken ligamentous tissues makes it less than an optimal therapy. I can see little point in permanently weakening a containment structure for the short term, transient, gain of pain relief. If the mechanical source of the pain is not eliminated, the result is probably equivalent to acupuncture or TENS--No cure, just a time-limited treatment. Be certain that, if you do resort to this therapy, you choose a physician highly skilled in this technique and the proposed benefits vs risks be clearly explained.

There is another important consideration inherent in the decision to subject yourself to this therapeutic modality. Cortico-steroids are rather powerful drugs in that they cause tissues injected with them to shrink and weaken (atropy). When a body tissue is inflamed, to shrink it is sometimes helpful because it causes the inflammatory process to be reduced as well. Injections for tendonitis or bone spurs are very effective in producing long-lasting benefit because they are injected into tissues that can tolerate the potential atrophy. In the case of a bone spur, the atrophy is intentional. However, the use of theses drugs in the presence of a disc herniation can easily be seen to cause the intervertebral or capsular ligaments to be weakened. Doing so, I believe, is potentially counter-productive in the long term because those are the precise ligament that you are relying upon to retain, move, and re-centralize the off-center disc material when doing the The O'Connor Technique ™ MANEUVERS to replace the de-centralized disc material. If these ligaments are weakened, they might not be strong enough to perform that function or, for that matter, the functions for which they were naturally designed.

Usually, by the time patients seriously consider this modality, they are desperate for pain relief. I would caution against making any desperate decisions without some certainty of true, long-term, benefit as well as the absence of permanent harm. I would insure that any genuine presentation of the risks, benefits, indications, and contraindications divulges the actual long-term success rates and quantifies the number of people who, nevertheless, went on to have surgery or got no substantial relief. The most recent article I reviewed on this subject found the results "equivocal."

Ideally, anyone faced with this optional therapy should try The O'Connor Technique ™ , first, and be certain that they cannot benefit by it before potentially atrophying the inflamed ligaments. They are most likely inflamed because of a constant abnormal physical pressure and traumatic stretching due to a bulging or off-center piece of disc material. If they are treated with cortico-steroids, they can be expected to not perform to their capacity and may even fail because of it. This could result in a nerve-damaging disc protrusion that otherwise might not have occurred–thereby potentially committing the patient to an inevitable open discectomy or fusion surgery. There lies grave importance in this decision because the new anterior approach percutaneous discectomy, artificial disc replacements, and internal fusion procedures might not be as successful in the presence of a weakened ligament structure since these procedures theoretically rely upon an intact disc capsule to be optimally successful.

Further Reading

Introduction
TENS (Transcutaneous Electrucal Nerve Stimulation)
Ice and Heat
Acupuncture
Trigger Point Point Injections
Epidural Steroid / Aneshetic Injections
Chemonucleolysis
Surgery
Percutaneous Diskectomy
Microdiskectomy
Laminectomy
Artificial Discs
Fusion

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