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Harvard Medical School
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General Medical Questions
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Q: I have persistent low back pain and my doctor suggested epidural injections. How well do they work? What are the risks?
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The Trusted Source
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Robert H. Shmerling, M.D.

Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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September 03, 2010
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A:

The effectiveness of epidural injections depends on a number of factors. The most important factor is the cause of your pain. For example, if pain is due to muscle spasm, an epidural injection is unlikely to be helpful.

Epidural injections usually include a combination of corticosteroids and a numbing medicine in the family of Novocain. The needle is inserted into the space just outside the spinal cord (called the epidural space). These injections are most commonly recommended to treat:

  • Osteoarthritis (or degenerative joint disease)
  • Disc disease
  • Spinal stenosis (a narrowing of the space where the spinal cord resides).

Studies of epidural injections suggest that they can be helpful for these conditions. However, not all studies demonstrate significant benefit. And even the ones that find benefit suggest that the primary role of epidural injections is to provide temporary pain relief for certain conditions.

As with any other treatment, epidural injections are not risk-free. The most common side effects include:

  • Discomfort or numbness during the injection
  • Headache, nausea and vomiting
  • Infection
  • Bleeding along the path of the needle
  • Nerve damage

Because of these risks, epidural injections are usually offered only occasionally (for example, a few times a year) and only for conditions in which improvement can be reasonably expected (such as those listed above). In addition, epidural injections are typically offered when other, less-invasive treatments (such as pain medications and physical therapy) are not effective.

Doctors performing these injections usually use a type of X-ray to confirm the proper location of the needle prior to injection. This helps limit complications. Fortunately, serious complications or side effects, such as infection or nerve damage, are quite rare.

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