Spinal injections to treat back pain are typically safe. However, side effects can occur, such as bleeding, infection, increased pain, headache, and more.
Doctors may suggest spinal injections to diagnose or treat a person’s back pain if it is severe and has not responded to other treatments.
A doctor usually performs spinal injections as part of a comprehensive treatment program, which may involve exercise and other therapies.
There are different types of spinal injections, such as epidural, nerve block, and provocation discography, which doctors also refer to as a discogram.
Doctors can inject into different areas of the spine. They may position the needle near the affected nerve or into or around the facet joints of the spine, the sacroiliac joints between the pelvic bones, or the affected “trigger” points.
This article discusses epidurals, nerve blocks, discography, and their side effects. It also looks at preventing side effects, whether injections for back pain are safe, and their success rates.
According to the American Academy of Orthopaedic Surgeons, spinal injections are typically safe. However, like with any procedure, side effects may occur. These include:
- bleeding
- nerve injury
- infection
- inflammation of the arachnoid, which is a membrane that surrounds the spinal cord
- spinal headache
- increased pain
- muscle weakness
An epidural typically treats pain that starts in the spine and radiates to other areas, such as the arms and legs.
During an epidural spinal injection, a doctor injects an anti-inflammatory medication such as cortisone, an anesthetic, or both near the affected nerve.
They place the needle just outside of the protective membrane that surrounds the spinal cord, called the epidural space. The cortisone reduces inflammation, which leads to pain relief.
Side effects
An epidural spinal injection may not produce any side effects.
However, side effects and complications can include:
- itchy skin
- low blood pressure
- slowed breathing
- loss of bladder control
- fever
- flushed chest or face
- anxiety
- difficulty sleeping
- changes in the menstrual cycle
- diarrhea
- nausea
- temporary increase in blood sugar
In
- severe breathing difficulty
- nerve damage
- prolonged numbness
- abscesses
- bleeding
- allergic reaction
- adrenal suppression
- epidural bruising
- infection
- spinal headache
- pain in the lower limbs or back
- paralysis
Doctors may use a nerve block spinal injection to treat acute or chronic pain that may originate in the spine and can radiate to the arms, legs, buttocks, and neck.
The injection contains an anesthetic, an anti-inflammatory medication such as cortisone, or both.
A doctor may perform a nerve block to switch off pain signals that a certain body part is sending, and to decrease inflammation. This allows the affected nerve, or nerves, time to heal without the stress of pain.
Side effects
Side effects may include:
- bleeding
- skin infection at the site of injection
- increased appetite
- flushed face
- menstrual irregularities
- temporary increase in blood sugar
- diarrhea
- nausea
More serious complications may include:
- infection
- damage to nerves
- spinal headache
- weakened muscles
- increase in pain
- death of bone tissue, called avascular necrosis
- a pain disorder called arachnoiditis
- paralysis
Doctors do not use discographies often. They typically only administer them when considering surgery to treat lower back pain.
A discography triggers pain so doctors can detect the source of discomfort. Doctors do not intend for a discography to reduce back pain. Rather, it helps diagnose the cause.
In a discography, a doctor injects a liquid into the jelly-like center of the disks of the spine. Doctors then monitor the disks to determine the location and type of pain.
Side effects
Side effects may include:
- aggravated pain
- infection
- bleeding
- nerve damage
- muscle weakness
- spinal headache
- arachnoiditis
Some people may not experience noticeable side effects.
A person may not be able to predict or prevent the side effects of a spinal injection. However, they can prepare by following the doctor’s instructions on medication, eating, and drinking before the procedure.
A person should rest for a few hours after the procedure, according to the doctor’s instructions. They should report any pain, bleeding, or other side effects to the doctor.
Spinal injections, such as epidurals, are typically safe. However, they do carry risks of side effects and complications.
Some people may not be suitable candidates for spinal injections. These include
- diabetes or high blood pressure that is not well managed
- anticoagulation or bleeding disorder
- allergies or hypersensitivity to steroid medication or anesthesia
- infection at the site of the injection
- congestive heart failure
While doctors consider spinal injections generally safe, severe complications may occur in rare cases. These include:
- convulsions
- severe difficulty breathing
- death
Before deciding whether to undergo spinal injections, a person can discuss the procedure with a doctor and carefully consider the risks and benefits.
The success rates of spinal injections can vary depending on several factors. These include:
- the type of steroid a doctor injects
- the underlying cause of the back pain
- where the needle is placed
- the person’s overall health
Studies have found that success rates vary for different conditions and different levels of severity of conditions. Rates of success for specific conditions according are as follows:
- Axial lower back pain: According to a
2015 study , 68% of participants felt more than 50% improvement in pain. - Foraminal spinal stenosis: According to a 2018 study, 87% of participants with mild to moderate stenosis reported improvement in pain levels, and 42% of participants with severe stenosis reported improvement.
- Lumbar herniated disc: According to a
2015 review , 40–80% of participants reported a more than 50% improvement in pain. - Neurogenic claudication: According to a
2016 study , 44% of people reported pain relief after 6 months of injections.
While some side effects may be mild and temporary, such as nausea, increased appetite, and flushing in the face and chest, others may require immediate medical attention.
A person should contact a doctor or seek emergency medical attention after a spinal injection if they experience:
- new or worse pain
- convulsions
- severe headache
- signs of infection, such as fever, skin inflammation, or swelling
- weakness or numbness in the legs or buttocks
- loss of bladder or bowel control
A doctor may suggest a spinal injection, such as an epidural, nerve block, or discography, if a person’s back pain has not responded to other treatments.
Epidurals and nerve blocks involve a doctor injecting anti-inflammatory steroids, anesthetic, or both into the spine to reduce inflammation and pain. A discography, or discogram, stimulates pain to help a doctor diagnose the cause of the pain.
There are potential temporary side effects of spinal injections, such as menstrual irregularities, skin flushing, nausea, and itching. In rare cases, a person may develop more severe complications. These may include convulsions, nerve damage, spinal headaches, bleeding, and infection.
A person can discuss the potential risks and benefits with a doctor before deciding to undergo the procedure. If a person experiences any serious side effects, they should immediately contact a doctor or emergency medical services.