You’ve tried everything, but medications and physical therapy aren’t enough to alleviate your back pain. 

Sound familiar? 

If you’re dealing with persistent nerve pain in your spine, your doctor may recommend an epidural steroid injection to treat your pain. Here’s what you need to know about this treatment option and how you can prepare for your procedure. 

What Is an Epidural Steroid Injection?

An epidural steroid injection is a treatment for chronic back pain. A shot of cortisone is injected into the outermost section of the spinal column, the epidural space. 

Cortisone is a type of steroid that occurs naturally in the human body, typically as part of our brain’s chemical response to stress. When the adrenal gland releases it, cortisone suppresses the immune system, dimming inflammation and, in turn, our perception of pain. 

Naturally-occurring cortisone is short-acting. Artificial cortisone, like that delivered in an epidural steroid injection, is designed to last for much longer–anywhere from a few weeks to months. 

How Does It Work?

The immune system is basically our body’s built-in defense system. It’s designed to fight against invaders, from bacteria to unknown viruses. So if you’re injured or something in your body isn’t working, your immune system is the first one on the scene, so to speak. 

The immune system’s first response is inflammation. The goal is to kill off as much bacteria as it can around the damaged site before it needs to call in reinforcements. 

Of course, your body isn’t meant to stay in a state of inflammation for an extended period of time–it’s a temporary measure until your immune system has moved on. So if the inflammation goes on for an extended period of time, it causes pain. 

When cortisone is released by the adrenal gland, it has the opposite effect–it suppresses the immune system in a targeted area, reducing inflammation and thus reducing the associated pain. 

When you get an epidural steroid injection, you’re taking advantage of naturally-occurring processes in the body. But instead of waiting for the cortisone to release on its own, your doctor is giving you a concentrated dose of artificial cortisone to hold the pain at bay for an extended period of time. 

What Is it Used For?

Epidural steroid injections contains cortisone that acts as an anti-inflammatory agent. It creates an overall pain-relieving effect for an extended period. 

This type of treatment is typically recommended for nerve pain in the spine, including: 

• Herniated disc
• Sciatica pain
• Spinal stenosis

What Are the Risks of Epidural Injections?

Generally, epidurals do not cause any ill effects. However, there are occasionally complications. 

When side effects do arise, a few common ones include: 

• Sleeping problems
• Steroid flush, or a rise in body temperature and flushing in the face and chest for several days
• Anxiety
• Water retention
• Menstrual changes
• Increased hunger for a short peroid of time

Another common risk is the accidental puncture of the dura mater, the tissue surrounding the spinal cord. When this happens, spinal fluid leaks out of the spinal cord, creating a spinal headache.

As the name implies, it’s an extremely intense headache that gets worse when you stand or sit and lessens when you lie down. The pain can range from a dull, mild throbbing to an incapacitating pain similar to a migraine. 

These headaches typically get worse before they get better. The good news is that they don’t tend to last longer than a few days. 

What to Expect

If you and your doctor decide that the procedure is the right option for you, it’s important to understand what you should expect.

Before

Before the procedure, your doctor will speak with you about your medical history, any current medications, allergies, and potential risks associated with the injection. If you are pregnant, nursing, or plan to be pregnant in the near future, make sure to tell your doctor. 

The doctor will also review any pre-operation preparations necessary. 

You won’t be able to drive after the procedure, so you should arrange for someone to drive with you and drive you back. Wear comfortable clothing and bring something along to occupy your time while you wait. 

During

The skin around the injection site will be cleaned with an antiseptic and the doctor will inject a  local anesthetic to numb the skin and deeper tissues or may spray a “cold spray” on your skin to numb prior placing the needle. 

You will lie down on an X-ray table. The procedure will cause some discomfort. With a local anesthetic, you’ll feel a strong pressure, but you shouldn’t feel much pain. 

Using fluoroscopy (a form of live X-ray) as guidance, your doctor will insert the needle and direct it toward the epidural space. Then, he will slowly release the cortisone and numbing medication. 

After

The full benefit of the steroids will take a few days to take effect but shouldn’t take longer than five to seven days. Keep in mind that every patient is different. 

If your symptoms are unchanged after a week, your doctor will investigate other potential sources of your pain. If the pain lessens but only for a short time, your doctor may suggest additional injections. 

Do You Need Epidural Steroid Injections?

If you believe an epidural steroid injection might be the right choice to treat your back pain,  we can help you.

NWA Interventional Pain is a comprehensive pain clinic offering solutions to your chronic pain. We individually tailor your treatment plan to ensure that we treat your pain in the manner that is best for you.

If you’d like to speak with us about your treatment options, use our contact page to get in touch. 

Freezing temperatures and icy ground conditions make going outside a risk you might not be willing to take. But did you know that movement can strengthen your back muscles and offer some pain relief?

Lower back pain has many possible causes including irritation to nerves and joint swelling. Treatment varies depending on the severity of the pain and how long you have been experiencing it. There was a time when doctors would prescribe bed rest, but research has proven that lying down for long periods does more harm than good.

Of course, not just any exercise will do. If you’re already in pain, then you’ve got to be careful with how you work those tender muscles. Avoid sit ups, leg lifts, and forward bends. Anything that works the hips puts extra strain on the back. Additionally, overhead weightlifting can compress the spine. Add high-impact aerobics, particularly those done on a hard surface, can be jarring on your back.

The right exercises can help to strengthen the back and the surrounding muscles, which can decrease stress on the back and allow for better mobility. Exercises shouldn’t focus solely on the back muscles. Weakness and tightness in the neck, shoulders, hips, glutes, hamstrings, and abdominal muscles can also contribute to back pain. Here are a few:

Stretch your neck and shoulders

First, gently bend your head forward, bringing your chin toward your chest until you feel a stretch in the back of your neck. Next, gently bend your head to one side as if you are trying to touch your ear to your shoulder. You should feel a stretch down the side of your neck and the top of the shoulder. Repeat this stretch on the opposite side.

Stretch your back

Lie on your back and bring both knees into your chest. Then flex your head forward until you feel a stretch. Next, lower both feet to the floor with your knees bent, and use both hands to pull one knee toward the chest. Repeat with the opposite knee.

Stretch the hips and glutes

Stand with your hips shoulder-width apart. Take half a step back with your right foot, and bend your left knee, shifting your weight to your right hip. Bend forward, keeping the right leg straight, and reach down until you feel a stretch. Repeat on the opposite side. Then, lie on your back and cross one knee over the other. While keeping your legs crossed, use both hands to pull the lower knee in toward your chest. Repeat on the opposite side.

Do low-impact cardio

Try walking briskly—either outdoors or on the treadmill. If you go to the gym, you can also try the stationary bicycle, elliptical machine, or step machine. The goal is to get your heart rate up without the jarring impact on your spine. Some patients find the “weightless” feeling of water exercises easier and less painful.

You should consult with your doctor before beginning any exercise program. If any exercise becomes too painful, discontinue that exercise. Exercise is always just one option when dealing with pain. If you don’t feel any relief after a couple of weeks, talk with your doctor about other noninvasive pain management techniques.

Sticking to your routine is important, but you also need to pay attention to repetitive motions that strain your back. A carefully structured exercise program can not only get you ready for beach season, but it can increase your comfort level.

Previously we wrote about pain self-management. Even though it still requires consultation with a physician, many patients can benefit from this approach.

Regular access to doctors is not always easy, self-care can help you work through tough times and maintain a normal life. Additionally, at least half of all patients manage their discomfort through a primary care physician instead of a board-certified pain specialist. Lack of training in the complexity of chronic pain management is one of the contributing factors to the over-prescription of opioids. If you suffer from chronic issues, self-care can help you avoid narcotic medications.

Your daily life plays a key role in managing pain. In fact, there are several positive lifestyle changes you can make to help manage your comfort. Two starting points are to eat a healthy diet and maintain a healthy weight. A few other everyday activities help:

Reduce stress

Pain and stress feed off one another. You can prevent this cycle by recognizing your stress triggers. Write down the things that cause your stress, considering each part of your life, including work, relationships, home, poor health habits, and perfectionism or negative thinking. Then take a hard look at the list and think about ways you can minimize or even eliminate those triggers. Practicing relaxation skills also helps approach your day from a calmer, more balanced and less stressful place.

Stay physically active

Aerobic or “cardio” exercise releases endorphins—the feel-good chemicals that act as your body’s natural painkillers. If you have pain from an injury, recent surgery, a physical disability or a chronic condition such as osteoporosis, it’s best to work with a physical therapist or exercise physiologist to be sure you can exercise safely and avoid hurting yourself.

Get enough sleep

Pain—and even some pain-related medications—might make sleeping difficult. On the opposite end of the spectrum, some pain medications can cause fatigue and make you sleep too much. But proper amount of sleep helps you cope with your pain by boosting your energy levels and your mood. Be strategic about your medications. Talk with your physician about timing so that you’re taking stimulants early in the day and drowsy medication closer to bedtime. It also helps to put more effort into your sleep hygiene and schedule.

Pain affects every aspect of your life. It can challenge or change the activities you choose to do, the thoughts you have and even the sleep you get. By learning to self-manage, you face your pain directly and learn to understand that living well is still a possibility.

Muscle and joint pains don’t directly result from chilly weather. The discomfort probably comes from bad posture or too much time in unnatural positions while working, driving, using your phone, or sleeping. The cold weather can make the pain worse and also increase the recovery time.

Some studies suggest that a drop in barometric pressure coming with low temperatures causes tissues around your joints to swell and pressures pain centers in your nerves. Others have pointed to common changes in the body in response to the cold. Blood vessels constrict to keep you warm and can also trigger pain receptors.

Some of these tips might help:

Change your sleeping habits

When you sleep on your stomach, you keep your neck moved to one side for hours. This can lead to stiffness and pain and also harm your muscles in the long-term. Sleeping on your back or on your side keeps your neck in the ideal position. You could also try sleeping without a pillow or get yourself a special pillow designed for the same issues. Pillows unfit for the structure of your neck can cause major pain and damage to the neck joint, which leads to long-term problems like spondylitis.

Stretch and exercise

Staying active keeps your blood flowing and increases joint health. Practice simple neck and shoulder exercises when you have a free moment.  In addition, always be sure to stretch all of your muscles to warm them up before any physical activity such as shoveling snow. 

Apply heat

Apply a heat pack to your neck or shoulder if it aches and leave it there for around 20 minutes or so. This will loosen the muscles and reduce inflammation that may be causing pain. Sitting in a hot bath or jacuzzi can also provide relief. Additionally, a massage with hot oil can reduce inflammation, relax muscles, and provide relief from stiffness and pain.

Drink plenty of water

While the hot cocoa or coffee may be tempting, it is still important to drink plenty of water. Your risk of dehydration does not disappear in the winter. Since spinal disks mainly consist of water, you need to stay hydrated throughout the day to keep your whole spine healthy and reduce the risk of injury to your neck.

While you won’t be able to avoid the stiffness caused by the cold, you shouldn’t just try to ignore it until it goes away. If you understand what effects cold air can have on tissues of the neck and shoulder region, you will be able to take positive action to help find some relief.

Yard signs of pain

Some see beautiful fall foliage. Others see leaves ready for raking. Unfortunately, you might suffer more than the loss of time. One of the most common complaints following a few hours of yard work is lower back pain. If you’re not careful, the repetitive and unnatural motions that come from raking, weeding, mowing, digging, planting, and mulching can wreak havoc on your back muscles.

Lower back pain is particularly common because the lumbar spine is both extremely flexible and tasked with supporting most of the body’s weight. This combination makes it easy to injure. The good news is that the majority of back aches and pains heal on their own or only require minimal treatment. However, if you’re someone who feels the strain long after you’ve finished in the yard, you should consider these tips:

Warm Up Take a few minutes to do some dynamic exercises such as a brisk 5 – 10 minute walk, jumping jacks, walking lunges, and arm circles.

 Hydrate Maintaining your body’s water levels helps prevent muscle cramps or spasms and dehydration.

 Mix It Up Vary your tasks each time and don’t continuously perform any particular activity for a long period.

 Use Correct Form Bend at the knees and hips and push with your arms and legs. Periodically switch to your non-dominant hand so that you’re not overusing one side of your body.

 Wear Supportive Shoes Good foot and arch support can stop some strain from reaching your back.

 Take Breaks Taking your time will make it less likely for injuries to occur from sloppy posture and lifting techniques.

Cool Down Walk around the yard to review all your hard work and end with some easy stretching to reduce stiffness and soreness.

Most importantly pay attention to your body while you’re doing the work.  If something doesn’t feel right, stop and figure out what could be the source and solution to your discomfort.

While you don’t want to feel pain during any season, fall can be especially rough because you begin slowing down activity as the weather cools off. You’ll become more aware of strains on your body during the winter because you’re not moving around as much.

If you are experiencing prolonged back pain, contact your doctor to discuss treatment such as heat and ice therapy, physical therapy, or anti-inflammatory medication. More serious treatment would require consultation with an experienced pain management specialist.

 

 

Regardless of whether you have a trick-or-treater in your house, candy is all around you these days. And let’s be honest, sugar is all around you every day. According to the U.S. Department of Agriculture (USDA), the average American consumes roughly 69 pounds of cane sugar and 57 pounds of high-fructose corn syrup per year.

You’re probably well aware of the usual sugar suspects, but there are also hidden sugars in most processed foods. This includes many so-called “healthy” foods such as whole grain breakfast cereals, granola bars, pasta sauce, yogurt, and sports drinks. And while obesity, diabetes, and heart disease are certainly enough to scare you, did you know that sugar can cause your muscle and joint pain as well?

Research shows that sugary foods cause a spike in a hormone called insulin, which leads to the production of inflammation. Insulin secretes from the pancreas and is responsible for taking sugar out of the blood stream and storing it in the cells. This also contributes to the accumulation of fat. Visceral fat, or stomach fat, itself secretes proteins and hormones that generate chronic inflammation. Most forms of joint pain and muscle aches involve inflammation, and even if your pain has other causes, high sugar foods can magnify symptoms.

To be fair, sugar does have benefits: It supplies instant energy, stabilizes low blood pressure, and raises your spirits—all of which can be necessary in certain situations. Luckily there are naturally occurring sugars in fruits and vegetables that help you get what you need when you need it. Your sugar dependence also has a biological purpose. In the hunting and gathering days, people knew that if a food tasted sweet, it was ripe and not poisonous. The main culprit in staying healthy is “added sugar,” which is taken from its original source and added to foods and drinks to serve as a sweetener or increase shelf life. When doctors tell you to avoid high sugar foods, they’re likely talking about this type.

One extremely important fact about sugar is that it’s addictive. The sweet stuff releases dopamine and natural opioids in the brain. These are the same chemicals found in highly addictive painkillers, so your craving might be a lot stronger than you think. Unfortunately, you can’t simply quit sugar because in some cases the withdrawal symptoms are just as bad as narcotics. As is often the case with your health, moderation goes a long way.

Here are some tips for reducing your sugar intake:

• Clean out your kitchen to remove temptation, especially when you are hungry.
• Check food labels for brands and products with less added sugar.
• Plan your meals out beforehand when you’re not stressed, tired, or hungry so that you can pay closer attention to sugar content.
• Avoid sugary drinks, which can easily fill your daily healthy limit of sugar in a single serving.
• Exercise 20 minutes a day to increase your energy levels and reduce the need for a sugar boost.
• Avoid sugar alternatives and substitutes so that you’re controlling your body’s craving for sweets.

Cutting back on sugar is certainly not effortless—especially with temptation all around. But once you get through the rough patch and begin to feel the benefits, you’ll have no trouble passing on the sweets.

 

 

It had to come from somewhere. Whether it’s a pulsing throb or a shooting dagger. Whether it’s in your neck or your lower back. Whether it’s consistent or intermittent. There must be a specific cause that led you to the doctor.

However, once you’re in your physician’s office, there’s a good chance that you’ll become flustered. Without giving much context, you’ll just say, “It suddenly showed up” even though you and your doctor both know that’s not true. Studies show that only 21% of patients think that talks with their doctors went well. There are many reasons for this—not the least of which is poor bedside manner—but you need to fight the urge to quickly summarize.

Even if you think a pain is sudden, there is most certainly a cause. A good doctor will spend time getting to know you and the cause of your pain. Your job is simply to tell your story.

Pain is subjective.  One person can never know exactly what another person’s pain feels like.  So, particularly when you’re talking with your doctor, it’s important to describe your pain in a way that will give him or her the best picture possible of what you’re experiencing. Feel free to think this through ahead of time and write it down. Your doctor will appreciate that you’re telling the whole pain story.

Here are some tips to ensure that your doctor learns everything about your pain story:

Start at the beginning. Don’t just talk about when you first felt the pain. Go into detail about any stress you placed on that part of the body or recent changes to your daily routine. If nothing has changed, talk about any routines that may affect that part of the body and how long you’ve been doing them.

Use concepts such as timing, pace, the onset of symptoms, severity, and changes over time. These are key to arriving at your diagnosis and will come through naturally if you tell your story from the beginning.

Provide your doctor with context tied to other events. Don’t worry about remembering exact time and dates as much as what was going on in your daily life. Understanding the context can help you and your doctor identify factors that make your symptoms better or worse.

Describe the impact on your life. Your doctor’s office will ask you to quantify the pain in an objective way. That doesn’t tell as much of the story as whether you had to miss school or work.

Share your impressions with your doctor as you go along. Your initial reaction and self-diagnosis play roles in the development of the pain. If something about your symptoms surprised you, emphasize it.

Use simple language. Don’t try to use medical jargon. It confuses your doctor if you use it incorrectly.

Share your concerns. Let your doctor put you at ease. Don’t forget, there’s a mental component to pain too.

Don’t forget that communication works both ways. You should always find a doctor whom you feel that you can trust and who will listen to you. A two-way conversation about your health is the only way they will make the correct diagnoses and treatment recommendations.

 

If you’re going away on a vacation this month or even just staying close to home and relaxing, the change in routine might make you more aware of that back pain that’s been bothering you for a while. But you’ll learn soon enough that you can’t ignore the problem until it goes away.

Chronic back pain lasts three months or longer. It doesn’t have to be consistent discomfort, so if you have pain that comes and goes, it might be a result of the same problem. It can be difficult to pinpoint the exact source of your issues, but chronic back pain is usually related to age or a prior injury.

You want to be careful not to make any decisions on treatment until you have clearly identified the origin of your pain. Treating the wrong problem can make the pain the worse.  Back surgery, especially, should only be your last resort. It is an extremely serious procedure that can cause more harm than good. Luckily, there are effective nonsurgical treatments for chronic back pain:

 Physical Therapy

Exercise is one of the first treatments you should try under the guidance of your doctor, who will help you develop a tailored regimen to your specific symptoms. Through aerobic and flexibility exercise, you will focus on retraining your posture and strengthening your core. Usually, physical therapy will test the limits of your pain tolerance so that you can make incremental improvement.

Mindfulness

To manage the frustration, depression, and other psychological aspects of dealing with chronic pain, your doctor might refer you to a specialist who will recommend relaxation strategies to keep your mind from focusing on the issue. These include meditation, yoga, and tai chi.

 Diet

Some diets are highly inflammatory—especially those high in trans fats, refined sugars, and processed foods. Consult with your doctor to see if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help you feel relief by reducing the pressure on your spine.

 Lifestyle Modifications

Listen to your body and learn to adapt to your circumstances. Take a break when doing yard work or make several trips when carrying groceries. Pay attention to the movements that increase your pain and avoid them if possible. Not only could this help your back feel better, it could also prevent the underlying condition from advancing. If you are a smoker, you have another reason to kick the habit. Nicotine can magnify pain and delay healing.

 Interventional Pain Management Techniques

Nerve blocks, epidural steroid injections, nerve ablations, and other types of injection-based procedures provide relief directly to the source of the pain. Since they are usually localized to a specific area of the body, your doctor can also use these treatments to isolate the cause of your discomfort. Depending on the severity of the pain, one injection might be all you need to feel relief, but if necessary, you can repeat treatment every few months. Injections take place around important structures such as nerves, blood vessels, and spinal fluid, so you want to make sure that you work with a trained interventional pain doctor.

Nearly 50 million adults suffer from chronic pain, but you don’t need to give up hope. With the right treatment, you will be able to manage your pain and go back to focusing on the things that make you happy.