Usually the first line of defense is the patient’s family doctor, who may be a general practioner or a internal medicine doctor. The GP is more likely to offer an exercise regimen, non steroidals, muscle relaxants and the ice, heat routine. This is often a satisfactory treatment for patients with back strain from heavy lifting, or other mechanical injury. Internal medicine doctors are more apt to refer their back pain patients immediately to an othropedic specialist who may also determine after their physical exam that the source of pain is a mechanical injury and prescribe a similar treatment with or without physical therapy.
Those patients who don’t respond to conservative therapies may be candidates for the next level of therapy; epidural injections.
First of all, the physician will send the patient for radiographs of the spine, and then if the xray shows any abnormality, he may prescribe an MRI, which will give a detailed image of the spine and it’s components. It will show problems with alignment, arthritis, disc degeneration and other conditions.
Then the patient will make an appointment with a pain management physician who is a specialist in treating patients with back pain among other pains and also may be an anesthesiologist. The pain management specialist will take a detailed medical history which will include information about lifestyle, exercise, diet, etc. A physical will be done, including reflexes, sensation, and strength. If the pain management specialist feels the patient will benefit from the steroid epidural injection, it will be scheduled at that time.
The day of the steroid epidural injection will come with the patient having fasted after midnight and nothing by mouth in the morning. All jewelry should be left at home, along with any valuables in the female patient’s handbag. Comfortable, easy to remove clothing should be worn.
The patient will arrive at the facility and speak briefly to the registration person. Then she will be lead to a small room where she will undress and put a hospital gown on, and her temp, blood pressure and pulse will be taken. Then an intravenous line will be started. All the drugs the patient will get during the procedure will be given through this line.
The patient will walk to the room where the injection will be given. In many facilities, the patient will sit on the end of the bed or on their side for the procedure. But state of the art injections are given under fluoroscopy with the patient laying on their stomach. In this way, the physician can guild the injection to the exact space where the patient’s pain originates.
After the injection is given, the patient will go to the recovery room for one half to one hour, then back to their room to dress and go home. With two days to two weeks, evidence of the effectiveness of the injection should be apparent. Up to three injections may be necessary to obtain relief.
