My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Epidural Steroid Injections [Read/Print full article]
Overview
.
An epidural steroid injection (ESI) is a common treatment for pain related to certain spine conditions. The medication injected is often a combination of steroids and possibly a local anesthetic that is administered into the epidural space surrounding the spinal nerves. The steroid medication may reduce the inflammation and pressure on the spinal nerves that are causing pain. Epidural steroid injections can provide pain relief for a number of conditions including:
- Compression of the spinal nerves due to narrowing of the spinal canal (spinal stenosis)
- Sciatica from compression or inflammation of a nerve due to disc herniation or degenerated discs
The purpose of an epidural steroid injection is to reduce pain to allow you to function comfortably in your daily activities.
How You Prepare
.
The procedure is performed on an outpatient basis, meaning it usually does not require an overnight stay.
You may be asked to avoid eating or drinking anything for a specified time prior to the procedure.
You need to arrange for someone to drive you home after your procedure. Before your procedure, make sure you let us know about:
- Any prescription or over-the-counter medication you are taking, like:
Blood thinners. Consult your pain doctor regarding how long before the procedure to stop blood thinners. You may need to check with the doctor prescribing the blood thinner to make sure it is safe to stop.
Diabetes medicines. Consult your doctor regarding any possible dose adjustments you may need if you are not eating prior to the procedure. - Any allergic reactions you have ever had to medication or anesthesia.
- If you are having, or have recently had, symptoms of infection such as fever or chills.
- If you are pregnant
What You Can Expect
.
Our goal is to keep you comfortable and safe for your procedure. An intravenous line may be placed before the procedure to allow administration of intravenous medications, if needed.
Your back will be cleaned with an antibacterial solution. We then inject a local anesthetic into the skin in this area. You may feel a stinging or burning sensation with the local anesthetic.
After the skin is numb, the epidural steroid injection is performed. X-ray guidance may be used for the procedure.
Risks
.
An epidural steroid injection is a safe procedure. Temporary side effects may include increased pain, muscle weakness, and numbness in the legs.
Occasionally, spinal headaches may occur after the procedure.
Other rare risks include:
- Infection
- Bleeding
- Nerve injury
- Allergic reaction
- Hematoma (blood collection)
- Total spinal anesthesia
- Bladder or bowel dysfunction
- Paralysis
Side effects of steroids may include:
- Weight gain
- Flushing
- Sleep difficulties
- Elevated blood sugar
- Elevated blood pressure
- Anxiety and mood swings
- Irregular menses
Other very rare side effects of steroid medication include arthritis, stomach ulcers, hormonal changes, and cataracts.
When It Is Not Recommended
.
We likely will not recommend a epidural steriod injection if you:
- Are taking a blood thinner, such as warfarin (Coumadin) or Plavix, and are not able to stop prior to procedure.
- Have poorly controlled diabetes or heart disease.
- Have a fever or infection.
- Are pregnant or may be pregnant
Results
.
The degree and duration of pain relief varies among individuals.
The pain relief may last from a few days to many months. Depending on your individual circumstances, your pain or spine doctor may recommend repeating the injection.
The steroid medication usually takes a few days to achieve a desired effect. Some people may experience immediate relief, while others may require several days to start to notice significant improvement.
The injections may not provide pain relief for every person. In this case, you should follow up with your spine doctor for further recommendations.
After Your Procedure
.
You will be monitored as you recover from your procedure. Before you leave, you may be advised of restrictions on driving for a specified time. You will also be advised on when you may resume eating or drinking. You can otherwise maintain your routine activities.
You may experience the following common effects after the procedure:
- Weakness in your leg and foot
- Soreness at the injection site
Most of these effects are due to the local anesthetic and will wear off in a few hours.
To help relieve soreness at the needle injection site, you can try applying an ice pack for about 15 minutes at a time every hour. You may also take over-the-counter pain medication such as acetaminophen.
Typically, you may be able to go back to work the day after your procedure.
Call us if you:
- Experience a severe headache, particularly one that seems worse when standing or sitting.
- Have any new muscle weakness or numbness in the limbs lasting longer than 12 hours or increasing over time.
- Lose sensations or control in your arms or legs.
- Lose control of bladder or bowel.
- Experience sharp pain in your back, neck, arms, or legs.
- Have fever or chills or any other signs of infection at the site of the injection.
- Experience unusual bleeding.
If you experience an emergency, call 911 or go to the nearest emergency room.
Your Care with Me
.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
Typically, you are sent to my because your personal or referring physician facilitated the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together.
During your office visit, we will discuss your medical and family history, and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and any recommended procedures. Together we will create a treatment plan that is right for you.
.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.
.
Coordinating Your Care
.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
If you call the Appointment and Advice line
- Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location.
- The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.
If you come to an office visit
- At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
If I prescribe medications
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
- Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
- Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If I refer you to another specialty colleague
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
.
.
If a procedure is a treatment option
I will recommend that you review educational information and tools to help you prepare for your procedure. The information will often help you decide whether a procedure is right for you. If you decide to have a procedure, the information will provide details about how to prepare and what to expect.
If we proceed with a procedure, I will have my Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure.
.
Convenient Resources for You
.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
Manage your care securely
- View and compose secure e-mail messages.
- Manage your prescriptions.
- View your past visits and test results.
- View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
- Read about causes, symptoms, treatments, and procedures.
- Find interactive health tools, videos, and podcasts to help you manage your condition.
- View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
- Locate health education classes and support groups offered at every medical center.
- Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
- View your Preventive Services to see whether you are due for a routine screening or updated immunization.
.
Related Health Tools:
Podcasts
- Ease Pain Ease Pain
Prepare for Your Procedure
- Anesthesia for an Adult (Emmi) Anesthesia for an Adult (Emmi)
- Taking Warfarin (Coumadin®) (Emmi) Taking Warfarin (Coumadin®) (Emmi)
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.