The adrenal glands present in our body release a steroid hormone known as cortisone when it is under stress. This hormone has the natural ability to suppress the response of the immune system which in turn helps to control pain and inflammation in the body. Cortisone used as injections is a form of steroid medicine and is produced synthetically. Back pain is triggered due to swelling in the back muscles, nerve roots or the tissues around the spine for one reason or the other. When doctors administer cortisone injection, the pain subsides within a short span of time and the mobility of the painful back improves.
There are three different types of cortisone injections that are used for back pain. They are: facet joint injection, nerve root block injection and epidural steroid injection. Facet joint injection is effective when the tissues around the spines are inflamed, and it is given into a facet joint situated at the back of the vertebral bones. This is mostly used for relieving neck and upper back pain. On the other hand, nerve root block injections are administered in the area near the spinal nerve roots to reduce pain, particularly, in the lower back region.
Among all the three cortisone shots, epidural steroid injection (or ESI) is widely used for the treatment of back pain. There is a membrane known as dura mater which provides a covering to the spine and the underlying nerve roots of the neck area. The region in between the dura mater and inner surface of the skull is also known as epidural space and several nerves travel through this space towards the neck, shoulder and arms. Swelling or irritation in these nerves leads to neck pain, shoulder pain, and upper back pain. As the name suggests, epidural steroid injection is applied directly into the epidural space. This in turn will help to bring down the pain in back, neck or shoulders and other associated symptoms like tingling and numbness.
The procedure used for administering cortisone shots largely depends on the condition of the patient. Here, we are going to talk about a general procedure often used for applying epidural steroid injections. The patient is first positioned on the X-ray table in such a way that the doctor can visualize the X-ray of the patient's back for guidance. The skin of the back is then thoroughly cleansed with the help a sterile scrub. After that, a small area near the spine, where the shot will be pushed, is anesthetized with medicines. When the area becomes numb after a few seconds, the doctor directs a needle into the epidural space referring to the live X-ray. Once the needle is placed, a small amount of dye is injected through it in order to confirm that the needle is rightly placed. Then the right dosage of cortisone solution is pushed into the back. The patient is monitored for the next 15-20 minutes before he or she is allowed to go home. Some patients feel soreness at the site of injection for one or two days and the back pain worsens during this time. However, their condition improves within a few days.
The effect of cortisone injections varies from person to person. Some people get substantial relief from their back pain while there are others who do not notice any signs of improvement. The effect of the injection may last for just one week or up to one year. In other words, it helps to get rid of the swelling only temporarily but does not cure the pain. It does not address the root cause of the problem. Hence, it has to be applied again and again. It is a type of catabolic steroid, which means that it destroys the connective tissues in order to relieve the swelling. Thus, it has a damaging effect on the body. Other side effects that are observed after its prolonged use are weight gain, decrease in bone density and increase in blood pressure.
Application of steroid shots provides a lot of relief from a chronic back pain but it is not suitable for all. Pregnant women, patients with bleeding disorders, those who are suffering from any systemic infection or are allergic to cortisone should not use these injections for back pain relief. If the heart condition of the patient is not good, cortisone should be strictly avoided.