According to Dr. Richard Staehler, medical writer for Spine-Health.com, epidural cortisone steroid injections have been used to treat low back pain and problems, including sciatica, since 1952. Cortisone injections are used to manage the pain and inflammation associated with sciatica, though they are rarely the sole solution. A comprehensive treatment plan for sciatica often includes several other factors, including physical therapy, lifestyle changes and core-strengthening exercises.
What Is Cortisone?
Cortisone is a naturally occurring hormone in the body. It is produced by the adrenal gland on top of the kidney. The cortisone used in epidural injections for sciatica is a semi-artificial form that is useful to suppress inflammation. Sciatica pain is usually a side effect of an inflamed, bulging or herniated disc that presses on the sciatic nerve. Epidural cortisone injections deliver cortisone directly to the problematic area, which makes pain relief and decreased swelling more focused than traditional painkillers and oral steroids.
Epidural cortisone injections are delivered directly into the space in the spine. Anesthetics, such as lidocaine or bupivacaine, and saline solutions are commonly combined with the cortisone to wash away any inflammatory objects or substances around the painful area. If the first injection is effective at relieving pain and inflammation, a patient can have up to three cortisone injections per year.
Epidural cortisone injections can help block inflammation caused by chemical and mechanical factors, such as a herniated disc. Cortisone also helps partially block the immune system’s response to reduce pain caused by inflammation. The positive effects of cortisone injections for sciatica tend to be temporary, lasting from a few weeks to a year. The long-term benefits of cortisone injections are debatable, and studies often do not distinguish between the types of injections used and the types of pain they are used on. A 1998 study published in the Archives of Physical Medicine and Rehabilitation found that 80 percent of patients with persistent sciatica experienced some pain relief with epidural cortisone injections, while only 48 percent reported pain relief from a placebo saline injection.
Some patients should not receive cortisone injections. Patients should discuss any prior medical history and concerns with their doctors before deciding on cortisone injections as a potential treatment for sciatica pain. Patients who have any type of infection should avoid steroid injections until the infection has cleared. Pregnant women should be cautious about receiving cortisone injections. Fluoroscopy, a type of x-ray used to monitor the delivery location of the cortisone cannot be used on pregnant women. Patients who take blood thinners or have a bleeding problem, such as hemophilia, should also avoid epidural steroid injections.
Side Effects and Risks
Since cortisone is a naturally occurring hormone, there are no allergic reactions. Some patients may experience allergic reactions to the anesthetics combined into the injections, however. Most side effects are mild and occur less frequently than with oral steroid use. Common side effects include anxiety, facial flushing, fever, ulcers, insomnia and headache. Risks that are more serious are rare and include infection at the injection site, bleeding and nerve damage.