If your lower back pain makes it difficult to get back on normal activities or attend physical therapy, then you can try lumbar injections to relieve your pain and improve your back functionality. Learn about Lumbar injections via FAQs in this article. Visit the best Pain Management Clinic in Brooklyn at Doral Health & Wellness or log on to www.doralhw.org.

FAQs on Lumbar injections

These FAQs will help you understand what you need to know about lumbar injections. It includes:

1. What are lumbar epidural steroid injections and their goals?

Ans. This injection contains a powerful anti-inflammatory medicine (a steroid or corticosteroid) that delivers medicine directly into the space outside the sac of fluid around the spinal cord (called the epidural space).

The main goal of lumbar epidural steroid injections is to manage chronic pain caused by irritation and inflammation of the spinal nerve of your lower back due to certain conditions or injuries. This type of chronic pain is called lumbar radiculopathy, which radiates down from your lower back to your hips, legs, and feet. Other goals of using lumbar injections are:

• Pain control by lowering inflammation in and around the nerve roots.
• Improved mobility and function in the lower back and legs.
• Allowing the patient to take part in comprehensive physical therapy and rehabilitation programs to make progress in managing back pain.
• This injection may lower the need for more invasive procedures like surgery for pain management.

• What are the common uses of lumbar epidural steroid injections?

Ans. Doctors use lumbar epidural steroid injections to manage lumbar radicular pain, often caused by spinal nerve root inflammation and irritation in your lower back. Lumbar radicular pain is also known as sciatica. This condition causes several symptoms like pain, numbness, muscle weakness, and tingling which radiate from the lower back down to the leg, knee, calf, and foot.

Many conditions can irritate your spinal nerve roots in the lower back and cause lumbar radiculopathy:

• Lumbar herniated disk:  This condition is also known as a slipped/bulging/ ruptured disk. The disks of the spinal cord are soft, gel-like centers and have a firmer outer layer. Over time or with an injury, that outer layer gets weakened and starts to crack. This lumbar herniated disk happens when the inner substance starts to push through a crack in one of the disks between two vertebrae in the lower back. The leaked substances may put pressure on or irritate nearby spinal nerves.
• Lumbar degenerative disk disease:  This condition occurs when the cushioning in between the vertebrae in your lower back starts to wear away. This could cause local inflammation in spinal nerve roots.
• Lumbar spinal stenosis: This condition causes the narrowing of one or more spaces within your lumbar spine. This further decreases the amount of space required for your spinal nerve roots. A tightened space causes nerves to get irritated or pinched, leading to lower back pain, especially with repeated activity like walking.
• Lumbar osteoarthritis: This condition occurs with changes in the bones, disks, and joints in your lower back caused by the normal wear and tear of aging. This can lead to the narrowing of the interior structure of the spinal column of your lower back or in the opening where the spinal nerves exit, which causes inflammation and irritation to the nerves.

Other conditions that can be treated with lumbar ESIs may include:

• Localized lower back pain: This pain can vary widely and has many causes. It can cause a sharp or dull pain that you experience constantly or infrequently, and pain can range from mild to severe.
• Neurogenic claudication: This condition occurs when spinal nerves get compressed in your lumbar spine, which causes pain or tingling in your lower back and affects the lower parts of the body. Its symptoms mostly occur when you’re standing upright or walking.
• How should you prepare for lumbar injections?

Ans. Before getting this injection, you should tell your doctor if you’re pregnant or might be planning on getting pregnant in the near future. You should also tell your doctor about what medications you are taking, including herbs, supplements, and other non-prescription drugs. Your doctor then gives you instructions you should need to follow before the lumbar injection. Make sure you follow the instructions carefully. It may include:

• Limit your eating and drinking for a certain time before your lumbar injection.
• Adjust certain medications you’re taking, especially blood thinner medications.
• Request for an MRI and CT scan of your back before this injection to determine the exact area that is going to be treated.
• Make sure you come with someone who can drive you home because you’re going to take a sedative with your lumbar injections.

If you have any doubts, you can ask your doctor to clear them.

• What to expect during the lumbar injection procedure?

Ans. A lumbar injection procedure is performed in a hospital or an outpatient clinic and hardly takes 15 to 30 minutes. It’s important to stay still during the procedure. There are different ways your doctor accesses the epidural space around the spinal cord of your lower back, which include:

• Interlaminar ESI:  In this method, the path of the needle is in-between the two laminae in your spine (to get to the epidural space). A lamina is a flat plate of bone that separates the vertebrae in your spine. The laminae in your spine form the outer wall of the spinal canal and protect your spinal cord. Providers use this method to provide temporary pain relief for disk herniation, spinal stenosis with or without radicular pain, and localized lower back pain.
• Transforaminal ESI: In this method, the path of the needle goes through the foramina, which opens through nerve roots and exits your spine. Providers commonly use this method to provide temporary pain relief for radicular pain caused by disk herniation or a specific injury to the individual nerve root.
• Caudal ESI: In this method, the path of the needle goes through the sacral hiatus, which is at the bottom of your sacrum and just above your tailbone, to reach the lowest spinal nerves. Your sacrum is a triangular bone in your lower back that is situated between your hip bones. Providers may use this method to provide temporary pain relief from failed back syndrome. This method has fewer risks than interlaminar and transforaminal ESIs.

The common steps of a lumbar injection procedure are:

• You have to change into a medical gown and lie on the examination table on your belly with a pillow under your abdomen. Your doctor may give you medicine to relax (like a sedative).
• Your doctor will properly clean the area of your lower back where the injection needs to be inserted to lower the risk of infection.
• Your doctor uses a type of imaging guidance called fluoroscopy to guide the needle to its exact position.
• Your doctor may inject local anesthesia with a small needle around the area to numb the area where the injection needs to be injected. This also ensures you don’t feel much pain when the injection needle (which is going to be larger) is inserted into the epidural space around the spinal cord.
• Then, the doctor injects a contrast material first to ensure the needle tip goes in the epidural space and not inside any other blood vessels or other tissue. This helps ensure the medication directly reaches the inflamed nerves they’re targeting.
• Your doctor will then slowly inject the medication, which is generally an anti-inflammatory medication such as a steroid and corticosteroid. Some doctors may inject a mixture of a corticosteroid, normal saline, and a local anesthetic.
• When your provider is done with the injection, they apply pressure to the site to prevent bleeding, clean the area again, and apply dressing to the site. You should move into a chair or bed to rest for a few minutes (to an hour). Your doctor makes sure you don’t have any reactions to the medication before allowing you to go home.
• Are there any side effects of lumbar injections?

Ans. There are several side effects you can experience, including:

• You may experience a temporary increase in pain before the steroid medication starts working.
• You may even have tenderness or bruising at the site of your injection.
• If your provider uses fluoroscopy for imaging guidance, then there might be low-level radiation exposure due to the X-rays. These X-rays may be harmful to developing fetuses, so make sure you tell your doctor if you’re pregnant or might be pregnant before undergoing this procedure.
• If you have diabetes, please inform the doctor; this injection may cause high blood sugar, which lasts for some hours or even days.
• If you have glaucoma, this injection may temporarily increase your blood pressure and eye pressure.
• How long do lumbar injections take to work?

Ans. Your pain may get worse for 2 or 3 days after the injection starts to improve your condition. These injections start working within 2 to 7 days and pain relief can last for several days to some months or longer.

• Are there any risks or complications involved with lumbar injections?

Ans. Lumbar injections are generally safe but there are some risks of certain side effects and complications. Although rare, these risks and complications can happen, which include:

• Low blood pressure that causes lightheadedness.
• Severe headache caused by spinal fluid leakage.
• Infection during the procedure, such as an epidural abscess, discitis, osteomyelitis, or meningitis.
• Having a negative reaction to medications like hot flashes or a rash.
• Bleeding if a blood vessel is accidentally damaged during the injection, may lead to hematoma or a blood clot forming.
• Damage to nerves at the injection site.
• You may temporarily lose control of your bladder and bowels. You may need a catheter in your bladder to pee.
• Getting ESI injections too often or getting higher doses of steroid medication may weaken the bones of your spine and nearby muscles. That’s why most doctors recommend only 2 to 3 ESIs per year.

Lumbar injections for lower back pain are an effective and generally safe therapy option for chronic lower back pain caused by certain conditions, especially a herniated disk and spinal stenosis. However, lumbar ESI will not cure the pain. But rather it provides pain relief so that you can return to your normal activities and improve your life quality and physical therapy. If you have doubts about lumbar injections, then talk with a doctor to know its pros and cons.

Need help with lumbar injections, visit our pain management clinic in Brooklyn to get professional medical help. Call us to book your appointment now!!!! If your pain needs professional assistance, visit our pain management clinic in Brooklyn today or call to get a consultation. The location at 1797 Pitkin Avenue, Brooklyn, NY 11212 is well-served by public transportation, including many bus routes, and the subway line. Visit our website at https://doralhw.org/department/pain-management/ or contact us on +1-347-384-5690 for additional details.