Vertos Medical Blog

When Epidural Steroid Injections (ESIs) Don’t Provide Lasting Relief

Updated May 1, 2023

When chronic back pain is caused by lumbar spinal stenosis (LSS), all you want is lasting relief so you can get back to your daily life. This was true for Dante Lavino, a patient who was struggling with constant and debilitating LSS pain. Dante’s ability to play golf declined and he even had trouble getting up from his couch. This simple action required him to lean on the coffee table and rest for 15 to 30 seconds before straightening himself up to begin walking. Over time, he was unable to walk without resting.

What are the long-term effects of lumbar spinal stenosis (LSS)?

LSS can cause thickened ligament tissue, excess bone, or bulging discs that can narrow the spinal canal and compress the spinal cord nerves in the lower back. This causes numbness in the lower back, upper legs, or buttocks. For Dante, his long-term pain meant little sleep, and even less activity. And this lasted for years.

Mayo Clinic states that in rare instances, untreated severe spinal stenosis may progress and cause permanent numbness, weakness, balance problems, incontinence, and paralysis. That’s why it’s so important to not just treat the symptoms, but address a major root cause of stenosis.

What are the treatment options for stenosis?

Typically, doctors recommend a course of treatment for lumbar spinal stenosis (LSS) that starts with conservative treatments like over-the-counter pain medication, physical therapy, or chiropractic care. While their safety profile may be strong, these treatments aren’t always effective for everyone. If the pain is still present, doctors may recommend an epidural steroid injection (ESI).

What is an epidural steroid injection (ESI)?

ESIs are commonly administered by pain management doctors to treat lower back pain, including symptomatic lumbar spinal stenosis (LSS). An ESI involves injecting a local anesthetic and a steroid medication directly into the space that surrounds the spinal cord and nerve roots. “While injecting a steroid medication . . . won’t fix the stenosis, it can help reduce the inflammation and relieve some pain,” Mayo Clinic states.

Dante’s initial treatment plan involved ESIs. “We were going to do epidural shots to see if that would relieve my pain and pressure. They gave me the first one and I felt like a new man. It worked great,” Dante said. “Then I had to go back in two weeks to get the second shot. Within a week’s time, that second one and the first one had already worn off. By the time I went back for my third appointment, I was just where I was before I even started the shots.”

According to Mayo Clinic, Dante is not alone in this experience as “steroid injections don’t work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so you can only get these injections a few times a year.”

How long do epidural steroid injections last?

The duration of the relief provided by epidural steroid injections can vary depending on the spinal condition being treated, the specific medication used, and the individual patient’s response to treatment.

The effects of an ESI may be short-term, lasting anywhere from a few days to several months, and may require repeat injections to sustain relief in patients with spine-related issues such as lumbar spinal stenosis. Some patients may experience immediate relief from their spine-related symptoms after the injection, while others may take a few days or weeks to notice a reduction in pain.

It is important to note that epidural steroid injections are not a permanent solution for chronic spine-related pain, and are often used as part of a broader treatment plan that may include physical therapy, medication, and other interventions.

If pain worsens after an ESI, it’s important for patients to discuss next steps with their healthcare provider and to work together to develop a personalized treatment plan that takes into account their individual needs and goals.

What are some of the reasons why epidural steroid injections (ESIs) don’t work?

Like Dante’s experience, ESIs may not always provide long-term relief for patients with lumbar spinal stenosis (LSS). Repetitive ESIs may provide short-term relief, but do not address a major root cause of stenosis. That’s because anatomical changes are necessary to relieve the pressure of stenosis. It’s helpful to think of stenosis like a kink in a drinking straw. Up to 85% of spinal canal narrowing is caused by the buildup and thickening of ligament that compresses the nerve and ‘kinks’ the straw. To reduce this narrowing and relieve pressure in the central canal (the fluid filled space that runs through the spinal cord), decompression is required. Therefore, repetitive ESIs may just mask the pain in the short term and delay long-term relief.

As the success rate on an ESI depends on the underlying condition of the spine, pain may still be present after an epidural steroid injection.

What is the next step if epidural steroid injections don’t work?

If epidural injections do not provide significant or lasting relief, it may be due to an underlying cause of the pain

Some potential next steps that a healthcare provider may recommend before pursuing more invasive procedures include:

  1. Consultation with a pain management specialist: For chronic, difficult-to-manage pain that hasn’t been relieved by an ESI, a healthcare provider may refer the patient to a pain management specialist who can provide additional treatment options and work with the patient to develop a comprehensive pain management plan. Patients can find a mild® Doctor using our online tool.
  2. Other non-surgical treatments: Depending on the back’s condition and symptoms, other non-surgical treatments such as physical therapy, chiropractic care, acupuncture, or pain medication may be recommended.
  3. Minimally invasive treatments like mild®: Unlike more invasive treatments such as spacer implants, fusion or traditional back surgery, mild® doesn’t eliminate future treatment options or other therapies for back pain. If symptoms persist or evolve, both conservative and more invasive therapies remain available. If the underlying cause of the pain is unclear or there are concerns about the effectiveness of previous treatments, further diagnostic testing such as imaging studies (e.g., MRI, CT scan) may be recommended.

What are the alternatives to epidural steroid injections (ESIs)?

An alternative to ESIs, or an option to consider if injections are no longer providing relief, is the mild® Procedure. mild® stands for minimally invasive lumbar decompression. It’s a short outpatient procedure that relieves pressure on the spine through an incision smaller than the size of a baby aspirin (5.1 mm). To restore space in the spinal canal and reduce the compression of the nerves—or in the case of the drinking straw, increase the flow—a mild® Doctor uses an imaging machine and specialized tools to remove small pieces of bone and thickened ligament. After looking at a mild® patient brochure, Dante talked to many people about the mild® Procedure, and heard he would be up and walking around in no time as most patients typically resume normal activity within 24 hours with no restrictions. So, he decided to give it a try.

Does the mild® Procedure work?

In fact, for many people, it does. mild® has a safety profile similar to epidural steroid injections (ESIs), but with lasting results. Clinical outcomes for the mild® Procedure include:

Walking / Standing Improvement

In a study performed at the Cleveland Clinic, at one year after the mild® Procedure, patients were able to increase their standing time from eight minutes to 56 minutes with less pain and increase their average walking distance from 246 feet (walking to the mailbox) to 3956 feet (walking around the mall).

Lasting Pain Relief & Increased Mobility

mild® demonstrated excellent long-term durability with significant improvements in both pain and mobility through 2 years. Clinical data from a MiDAS ENCORE 2-Year Study finds mild® provided patients with lasting pain relief and increased mobility.

Long-Term Durability

A five-year study performed at the Cleveland Clinic demonstrated that mild® helped 88% of patients avoid back surgery for at least 5 years, while providing lasting relief.

For Dante, his pain before the procedure was almost at a 10. After the mild® Procedure, he was at a zero. “I had no pain whatsoever,” he said. He is now back on the course, and ready to rejoin (and win) his golf league.

“Why live in pain when you don’t have to?”

Dante Lavino, mild® Patient

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