As a general internist and primary care provider, I have to say that it is well-known by PCPs and specialists that epidural injections are not effective for chronic low back pain. In 15 yrs of practice I can’t recall a pain specialist recommending ESI for back pain alone. Epidurals are often quite effective for radicular pain to the lower extremities. Sometimes the pain never returns. Other times it lasts only months but allows a patient to avoid surgery or high doses of pain medications. If partial or temporary effect is achieved, then I see them offer a second injection which is often more effective or longer lasting. I don’t recall ever seeing an interventional pain specialist give 3 injections when the first 2 were ineffective. I have seen many patients benefit. I’ve seen a much smaller fraction get no response. And though I know there are rare potential adverse effects, none of my patients have suffered any other than temporary soreness at the injection site or temporary elevation in blood glucose levels in diabetics (which can be easily managed).
Medicine is the application of current scientific knowledge to unique individuals. As such, it is imperfect but it is introspective and always adapting, growing and learning. It is unfortunate that investigative journalism, while serving an important function, has to sensationalize and divide to get the attention amidst all the other clamor. The mistrust that is engendered towards physicians in general is not constructive.
An example is those books titled “What your doctor doesn’t want you to know about… ” Really?
Please. We are all patients. Our loved ones are patients, too.
The Injection: These injections are done in the operating room on the operating room table with fluoroscopic guidance. They are usually performed in the face down or prone position on the operating room table. Antiseptic solution is placed over the low back or cervical or thoracic region at the site of the injection. Under sterile technique a generous amount of local anesthetic is placed with a very small gauge needle over that site. This is followed with a special epidural needle, which is advanced under fluoroscopic guidance until a specific nerve root is targeted. This is then followed with a solution of either normal saline or local anesthetic and steroid. The patient is once again kept in the surgical suite for 30 to 45 minutes for evaluation during and after the procedure. After the injection you may get immediate pain relief or it may take several days. Complications: If local anesthetic is used your legs, arms or thoracic region may be weak or numb for several hours so do not drive. You may want to use a heating pad or hot water bottle that night if your back is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one.
Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work). Patients who are being treated for chronic conditions (., heart disease, diabetes, rheumatoid arthritis) or those who cannot temporarily discontinue anti-clotting medications should consult their personal physician for a risk assessment.