Sciatica Keeping You Awake? How Targeted Injections Provide Fast, Lasting Relief

Sciatica is a condition where pain travels from the lower back into the buttocks and down the outside of the leg into the foot. It affects about 40% of Americans at some point in their lives. It occurs when something presses on the sciatic nerve root at the L4-L5 vertebral junction in the spine, causing pain, weakness, and numbness along its path.

At Interventional Pain Center in Norman, Oklahoma, anesthesiologist and fellowship-trained interventional pain medicine physician James Stephens, DO, and pain specialist Tyler Phillips, MD, provide pain management services, including diagnosing and treating sciatica.

Epidural steroid injections are used to treat several nerve-related conditions, including sciatica. If sciatica symptoms keep you up at night, here’s how these injections can help.

What causes sciatica?

Many problems can cause sciatica, all of which put pressure on, or “pinch,” the sciatic nerve or its root. Potential causes include lumbar spinal stenosis, where the spinal canal narrows and bone rubs against the nerve, and narrowing of the opening (foramen) at the L4-L5 junction, which can press on the nerve as it exits the canal.

However, the two most common causes are age-related. The first is a herniated disc. Between the spine’s bony vertebrae lie soft, flexible discs. They prevent the bones from rubbing together and help disperse the force placed on the spine with movement.

As these intervertebral discs age, though, they lose moisture, which can allow them to flatten or rupture (herniate). When the outer shell cracks, the inner gel can push into the spinal canal and onto the nerve root, leading to sciatica symptoms.

The second cause is bone spurs. With a lifetime of wear and tear, the protective cartilage around the bone breaks down, and bony outgrowths can develop. The spurs not only allow the vertebrae to rub against each other, but also extend into the canal, pinching the sciatic nerve root.

How targeted injections provide relief

An epidural steroid injection (ESI) is an injection of an anti-inflammatory medicine — a steroid or corticosteroid—directly into the epidural space around the spinal nerves. For sciatica, it’s injected around the sciatic nerve root and is called a lumbar ESI because it goes into your lumbar spine.

During an ESI procedure, the doctor injects a steroid along with a numbing agent like lidocaine into the epidural space, an area containing fat, blood vessels, connective tissue, and nerves.

Lidocaine provides immediate relief by numbing the nerve and surrounding tissues, while the steroid takes a couple of days to kick in, reducing inflammation around the nerve and relieving pressure that can worsen symptoms.

Lumbar ESIs are most effective when the pain stems from a pinched sciatic nerve caused by disc herniation or spinal stenosis. They’re not a permanent treatment, though, and provide relief for about three months or more. After that point, another injection can extend the relief period.

Some people don’t benefit much from ESIs; that’s why the doctor first takes a complete medical history, performs a physical and neurological exam, and evaluates any imaging studies to determine if you’re a good candidate. If you’re not, they evaluate other options to relieve your symptoms.

If you’re dealing with the pain and weakness caused by sciatica, Interventional Pain Center can help with epidural steroid injections. Call our office at 405-759-8407 or use our online booking tool to schedule a consultation with Dr. Stephens or Dr. Tyler today.