Epidural Steroid Injections for Neck Pain Relief

Epidurals are not usually the first recourse of physicians when addressing a patient’s neck pain; more conservative treatments are normally employed in the first instance, and often the neck pain will dissipate of its own accord. Many people suffer neck pain due to a herniated cervical disc, and in the majority of cases this heals within ten weeks leaving no residual pain. For patients with severe and persistent neck pain from conditions such as lumbar spinal stenosis, an epidural steroid injection can sometimes provide welcome relief. These injections are a combination of a local anesthetic and a corticosteroid which work to relieve pain straight away and have a longer-lasting effect as an anti-inflammatory to relieve some of the pressure on the spinal column, muscles and nerves.

Epidurals do not, however, cure the underlying condition causing neck pain, instead they can provide effective pain-relief and reduction in inflammation for a 2-3 week period in most cases. Epidural steroid injections are more commonly used in the lower spine, as their efficacy and safety in the cervical spine is less well documented. The complex nature of the anatomy of the neck makes it harder for physicians to pinpoint the correct area into which the injection should be administered.

Side Effects of Injections

Epidural steroid injections can also have side-effects, which means that physicians usually limit their use to no more than three a year, with at least a two-month gap between injections. Possible complications include tears of the dura and spinal fluid leakage. This is rare, but is more likely in the cervical spine than the lumbar region due to the complexity of the area. Oral steroids may be more appropriate for neck pain than steroid injections.

Medications used and Pretreatment Considerations

Some of the common medications used as epidural steroid injections include betamethason, methylprednisolone, and triamcinolone (their respective brand names are Celestone Soluspan, Depo-Medrol, and Aristospan). These are strong anti-inflammatories which are injected into the space around the spinal cord and roots of the nerves. The steroids work by reducing the oedema, improving micro-circulation and reducing ischaemia around the nerve roots. They also inhibit pro-inflammatory prostaglandin synthesis (an action shared by substances such as fish oil and flaxseed oil). Steroids also work through direct action in inhibiting C-fiber neuronal membrane excitation; which is a key source of the neck pain that can be a symptom of spinal stenosis.

If an epidural is recommended then the patient will likely undergo an MRI (magnetic resonance imaging) scan prior to treatment so as to ascertain the exact location of the troubled nerves. Epidurals are mostly conducted at outpatient clinics, or at the patient’s local surgery. Only qualified health professionals can administer the injections, such as anesthesiologists, radiologists, neurologists, and surgeons. Medical centers often have specific pain management clinicians who conduct epidurals and can advise on other methods to relieve neck pain from trauma such as whiplash, spinal stenosis, and arthritis.

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Last Updated: 11/20/2010