1. Epidural steroid injections
Almost everyone agrees that epidural steroid injections seem to work.
The questions are, how well do they work, what is the magnitude of
the benefits and how long do they keep the pain at bay?
"When we offer patients steroid injections, we order an MRI first to
see what the problem is. Then we can decide what sort of injections
may be beneficial," says Andrew Ng, MD, clinical assistant professor
of anesthesia and pain management at Jefferson University Hospitals
in Philadelphia.
The epidural steroid injection is mainly for spinal stenosis, disc herni-
ations or shooting pain down the legs, according to Dr. Ng. Typically,
you can offer the injection the first time to see how well the patient
does with it, then reassess the patient in 2 weeks and see how much
improvement they get from the injection. If the pain relief doesn't last,
the treatment can be repeated up to 3 times, says Dr. Ng.
"I have some patients, if I do one injection, it will last them for 2
years," says Dr. Ng. "Some patients get better for 5 days, then we
repeat, and they get better for 3 months. It varies depending on the
problem and severity of that problem. But on average, the injections
last 3 to 6 months."
Dr. Ng says the injections temporize the pain and make the patient
more functional in the short term. And they're an option if the patient
doesn't want to have surgery or isn't a candidate for surgery. There is
also a growing appreciation for the risks associated with steroids.
"With repeat steroid injections, like into tendons, you can rupture
the tendon," says Dr. Cohen. "It's also now known that they increase
bone mineral density, so it can expose people to osteoporosis.
Whether that leads to fractures is still debatable because the evidence
is mixed. And steroids can make diabetes worse in those who have
that."
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