I Am Not Having a Baby, Why do I Need an Epidural?
By Giovanni Ramundo, M.D.
If your doctor tells you that you may need an epidural do not panic! Most patients hear this and think “my wife had an epidural when she was having a baby so she wouldn’t feel anything from the waist down, why would I want that?!?!” We all know you want to feel everything from your waist down so please do not worry about that.
“Epidural” is a term used to describe the space in the spinal canal that a needle is being placed during an injection. The epidural space is the farthest area from the spinal cord compared to the other spaces (which is good). This space exists from the neck all the way down to the low back.
Your spinal cord runs through the space and you have spinal nerves that come off the cord on the right and left sides. Those nerves are responsible for giving you feeling, strength and reflexes. The nerves come out of spaces made by the shape of the bones (vertebrae) in your back covering the cord. You have discs that are in the spinal canal too that keep the bones far apart from each other to keep the spaces where the nerves come out open (foramen). The discs should be well centered. The nerves should not be touched.
If you hurt yourself from working out, lifting your child, bending the wrong way, are involved in a car or work accident…etc… one of your discs may become inflamed and bulge or herniate out of place. If the disc ends up touching a spinal nerve you may feel pain, tingling, numbness or weakness in the back, leg, foot, heel, toe, neck, arm, hand, or finger. Those spinal nerves are not supposed to be touched. If you have any of these symptoms you should check with your doctor for a possible MRI of the spine.
The inflammation from the disc may go away on its’ own with time. You may need an anti-inflammatory medication if you do not have any other medical problems that would not allow that (like a kidney problem, or are on a blood thinning medication or have a stomach ulcer.) You may need to try physical therapy or stretches and exercises. If you continue to have the symptoms then your doctor may talk to you about getting an epidural. This is when a skilled doctor would place a needle in the epidural space under an x-ray machine for guidance and inject a steroid medication into the epidural space at the exact location of your disc problem (which could be in the neck, mid back or low back.) The steroid medication would work over two weeks time to decrease the inflammation or swelling of the inflamed or bulging disc to get the pressure of the disc off of the spinal nerve. (For the record, when a woman is in labor a steroid is NOT injected, but a local anesthetic medication is injected instead to make a woman numb from the waist down. There is also no x-ray machine used for guidance when a woman is in labor as that would be harmful to the baby. When having an epidural for a disc problem we also numb the area where the needle is going in and you are able to have an IV placed for a “twilight” sedation which is not given to women in labor.)
Here is the tricky part…the injection can help a day to the rest of your life or anywhere in between. It can help 0-100% or anywhere in between. The goal is to place the medication at the exact location you need it to get the fullest amount of success. There are many ways a doctor is able to place the needle into the epidural space. After taking a proper history and performing a physical exam, and looking at your MRI, your doctor will know the best positioning for optimal relief. Depending on the amount of steroid in the injection you will be told how many injections you are able to safely have a year, that is, if you need more than one. The goal is always to get 100% relief if possible which means no one “needs three,” which is another myth out there.
There are always risks and benefits to every injection and you should discuss those with your physician. Epidurals are usually done by a pain management doctor. The goal is to help so you can avoid surgery if possible. By all means, have a surgical consult to see if that is option, but in most cases the conservative treatment of epidurals is recommended prior to considering surgery, unless there are more worrisome symptoms, such as severe weakness in the leg or arm or bowel or bladder problems. Do not be shy when it comes to discussing these symptoms or sexual dysfunction with your doctors. They are here to help!
Dr. Giovanni Ramundo is nationally board certified in anesthesiology and fellowship trained in pain medicine. He graduated medical school in 1990 at Penn State Milton S. Hershey Medical Center. After completing his residency, he was chief resident in the Dept. of Anesthesiology there from 1993-1994, he then completed his pain medicine fellowship at University Hospital at the Milton S. Hershey Medical Center from 1996-1997.