Lumbar epidurals are a commonly used treatment for managing pain, especially lower back pain and pain from childbirth. However, there is a lot of confusion around whether getting a lumbar epidural is a painful procedure. In this comprehensive article, we will look at what lumbar epidurals are, why they may be recommended, what the procedure involves, and whether patients typically experience pain during the process.
What is a Lumbar Epidural?
A lumbar epidural is a procedure where medication is injected into the lower back area to help reduce pain and inflammation. It is a type of regional anesthetic technique. The medication injected includes a local anesthetic, usually lidocaine or bupivacaine, and sometimes a steroid like cortisone.
The medication is injected into the epidural space, which is the area around the protective sac of the spinal cord and nerves. Introducing these medications into this space can help temporarily numb nerves and reduce inflammation, which provides pain relief.
Lumbar epidurals are most commonly used to manage:
- Lower back pain
- Sciatica
- Pain from spinal stenosis
- Pain during childbirth
- Pain after surgery, such as a lumbar laminectomy
For pregnancy-related pain, the procedure may be referred to as a lumbar epidural anesthesia or epidural analgesia.
Why Might a Lumbar Epidural Be Recommended?
There are several reasons a doctor may recommend a lumbar epidural procedure:
- To provide short-term pain relief – An epidural can provide targeted numbing of irritated nerves and reduce inflammation quickly to temporarily relieve severe back pain or labor pain when other treatments are inadequate.
- As part of a multi-modal pain management plan – Epidurals may be used in combination with medications, physical therapy, exercise, etc. as part of an overall pain management approach.
- To aid recovery after surgery – Controlling post-surgical pain with an epidural can make recovery easier and may allow patients to engage in rehabilitation sooner.
- To avoid general anesthesia during childbirth – An epidural provides pain control without sedating the mother, allowing her to remain awake during delivery.
- To diagnose the cause of pain – In some cases, injecting medication into the epidural space can help identify whether a specific spinal nerve is causing pain.
It provides targeted nerve numbing and pain relief directly at the source, compared to oral medications which circulate through the whole body. Epidurals allow normal muscle function to be maintained, whereas alternatives like spinal anesthesia lead to temporary paralysis in the numb regions.
What Does the Lumbar Epidural Procedure Involve?
Lumbar epidural procedures are most often performed in a hospital setting, although they may be done in an outpatient clinic or surgical center as well. They are always performed under sterile conditions by trained providers like anesthesiologists, pain management specialists, or obstetricians.
The basic steps are:
- Positioning – The patient either sits up and leans over a table or lies on their side curled up with knees pulled in towards their chest. This opens up the spine and intervertebral spaces.
- Cleaning – The provider thoroughly cleans the injection site on the lower back with an antiseptic solution.
- Numbing – A local anesthetic like lidocaine is first injected into the skin and tissues to numb the injection site.
- Needle insertion – A special epidural needle is inserted through the numbed area until it reaches the epidural space around the spinal nerves.
- Medication injection – Once placement is confirmed, the medication is slowly injected through the needle into the epidural space.
- Monitoring – The patient is monitored for a period of time afterward for effectiveness and potential side effects.
The provider may use ultrasound or fluoroscopy (live x-ray) guidance to ensure proper needle placement and spread of medication. Some providers also use a technique called a “loss of resistance” where they feel for a slight pop as the needle passes through the ligamentum flavum and enters the epidural space.
The whole procedure typically takes 15-30 minutes, depending on the providers technique and difficultly of needle placement. Many patients describe feeling intense pressure or a pushing sensation as the needle is inserted.
What Medications Are Used?
The two main medications injected in lumbar epidural procedures are:
- Local anesthetic – Usually lidocaine or bupivacaine. This provides numbing of the nerves.
- Corticosteroid – Usually a short-acting steroid like methylprednisolone or triamcinolone. This helps reduce inflammation.
For those getting an epidural anesthesia for childbirth or after surgery, only local anesthetic is typically used. For chronic pain patients, a combination of anesthetic and steroid may provide longer pain relief.
The medications work together to temporarily stop pain signals from the irritated spinal nerves from reaching the brain. This provides symptom relief but does not treat the underlying condition or cause of the pain.
Is the Epidural Injection Painful?
Many patients understandably wonder whether getting an epidural will be painful. There are several parts of the process that may cause some discomfort:
1. Needle Insertion
Inserting the needle can be uncomfortable, with most patients describing it as a pushing, stinging, or brief burning sensation. However, the provider first numbs the insertion site with a local anesthetic like lidocaine. This helps reduce the pain. For some patients, the numbing medication stings initially before the area goes numb. Using ultrasound or fluoroscopy guidance can also improve accuracy and reduce needle placement pain.
2. Pressure During Injection
As the medication is injected through the epidural needle, most patients feel intense pressure, cramping, or aching at the injection site or radiating down one leg. This sensation usually subsides once the injection is complete.
3. Discomfort Afterward
Some residual soreness at the injection site is common due to the needle and localization technique. Patients may also experience muscle cramps or aching as the medication begins to take effect. Your provider can recommend over-the-counter pain medications to use afterward if needed.
Helpful Tips to Minimize Discomfort
While lumbar epidural injections are generally well-tolerated, especially considering their pain relief benefits, there are some things you can do to make the experience more comfortable:
- Discuss anxiety or fears with your provider beforehand – They can help ease worries by explaining the process in detail.
- Arrange for someone to drive you home afterward.
- Wear loose, comfortable clothing.
- Try relaxation techniques during the procedure like slow breathing or visualization.
- Communicate with your provider – Let them know if you feel any concerning pain or sensation.
- Stay as still and relaxed as possible during needle insertion and injection.
- Remind yourself that any discomfort is temporary but the pain relief benefits last much longer.
- For post-procedure soreness, use ice packs and over-the-counter analgesics as recommended by your provider.
The Risks and Downsides
While epidurals are generally safe when performed correctly, there are some potential downsides and risks to consider. These include:
- Failure to provide relief – In about 10% of cases, epidurals do not adequately relieve pain for unclear reasons. Additional procedures may be needed.
- Temporary numbness – You may feel weak or numb in your legs or lower body after the procedure, but this should resolve relatively quickly.
- Nerve injury – There is a very small risk of nerve damage from needle insertion, resulting in chronic pain or neurological problems. Ultrasound guidance reduces this risk.
- Headache – Rarely, a severe positional headache can occur if the needle inadvertently punctures the outer membrane layers around the spine.
- Bleeding – Minor internal bleeding can occur which may result in temporary back pain. Serious bleeding is extremely rare.
- Infection – Infection is unlikely when sterile technique is used. Signs include fever and severe back pain.
Your doctor can discuss how these risks compare with potential benefits in your specific case.
Recovering From a Lumbar Epidural
Most patients can return to normal activity within 8-12 hours after the epidural injection. You will likely have some residual soreness at the injection site for a day or two. Avoid any strenuous physical activity for at least 24 hours.
The pain-numbing and anti-inflammatory effects tend to peak within 1-3 days. Pain relief typically lasts anywhere from a few weeks to several months, depending on the condition being treated before the effects wear off.
Your provider will advise when it is appropriate to receive another injection if your pain returns. There is some debate over how many repeat epidural injections are safe to receive over various periods of time due to a lack of extensive research.
Conclusion
While lumbar epidurals do come with some discomfort from needle insertion and medication administration, as well as a small risk of complications, these potential downsides are usually outweighed by the significant temporary pain relief they provide for many patients with spinal conditions and chronic lower back pain.
Talk with your doctor regarding whether a lumbar epidural may be appropriate for your particular diagnosis and situation. Be sure to express any concerns about pain during the procedure. Taking proper precautions and utilizing relaxation techniques can help minimize discomfort. With an experienced provider, most patients tolerate the procedure quite well given its benefits.
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References
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