Pinkerton Pain Therapy 

General Information:  A caudal epidural steroid injection with catheter placement may be used to help reduce the pain caused by a number of spinal disorders. The medicine used in the injection is usually a combination of local anesthetic, saline, and a steroid.  The patient will be positioned lying prone on a bed.  The doctor will use an x-ray machine called a fluoroscope to determine the positioning of the needle during the procedure.  During the procedure a small tube called a catheter will be threaded through the needle.  A small amount of dye or contrast may be used to verify medication placement.  The catheter is withdrawn after the procedure. 

Potential Side Effects:  Very few patients report side effects from epidural steroid injections.  The reported side effects and complications have been:

• Numbness or weakness in the legs: This can occur during or after the procedure.  In addition to blocking the nerves that cause pain, local anesthetics placed in the epidural space can block other types of nerves as well.  This generally lasts only a few hours.  You should notify your physician of symptoms lasting more than 24 hours.
• Bleeding
• Infection
• Post-dural puncture headache:  This type of headache is caused when the dura is punctured causing spinal fluid to leak.  This headache is characterized by exacerbation when the patient raises his or her head above the lying postion.  It may last for several days or longer.  It can be resolved with treatment.  If this happens, please contact your physician immediately or go to the emergency room.
• Steroid side effects:  Steroid administration can cause side effects such as flushing in the face or chest, elevated blood pressure, elevated blood sugars (especially in diabetic patients).

Additional Information: 

• Your pain may become worse for 24-48 hours.  The medication used to treat your pain has been deposited into a tight space and this may cause increased swelling and irritation around already inflamed nerves in the epidural space.

• You may have soreness at the injection site for 24-48  hours.  Avoid applying heat to the area during this time as this will increase swelling.  Use ice as described in your post-procedure instructions.  If any redness or fever occurs, contact your physician immediately or go to an urgent care.

• Additional injections may be needed to get your pain under control initially.  You may be asked to repeat the injection in as soon as 7-14 days.  If you still have pain one week after  you have received an injection and you do not have an appointment scheduled, contact your physician's office for instructions.

• The amount of steroid each patient may safely receive each calender year varies.  Your physician will determine what amount is appropriate for you and alert you if you are reaching the maximum dose you may receive.  If you are receiving steroid medication from other physicians it is important to notify your physician of this.

• We believe that exercise is an important part of maintaining a healthy lifestyle and has been shown to be extremely beneficial for patients suffering from back pain.  You will be given information on what exercise is appropriate for you.