Epidural injections (which treat pain and inflammation in the lower back) and their risks have recently been covered in the media. Like many medical procedures, epidural injection can be a blessing, but can also have some risk. Dr. Seth Waldman, director of the HSS Division of Pain Management, gives his guidance for considering an epidural and discussing it with your physician:
1. Spinal injection procedures may carry risk, and should not be performed casually.
2. Patients should make sure their doctor was trained and board certified in an accredited fellowship program.
3. Patients should check the accreditation of the facility in which the procedure is to be performed. This is a sterile operative procedure, and should only be performed in an appropriate setting, with the proper staff, monitoring equipment and emergency preparedness.
4. There is no magic to a certain number of injections (an automatic “series of three,” for example) – the risk and benefit of each procedure should be weighed by the doctor and patient.
5. It is perfectly appropriate to ask your doctor what kinds of medication will be used. Certain medications via certain injection routes (for example, cervical transforaminal injection with particulate steroid) carry a much higher risk than others.
6. It is also appropriate to shop around. If your doctor won’t discuss these issues with you, or do not receive acceptable answers that justify the risk (vs. benefit) of the procedure, you should not go ahead with it, and should find another doctor.
Seth Waldman, M.D. is the Director of the Division of Pain Management at Hospital for Special Surgery. Dr. Waldman has more than 15 years of experience in the field of interventional and medical pain management. He specializes in therapeutic and diagnostic spinal injections, and the management of neurologic pain.