a. What is in injectable solution? Injectable solutions usually content local anesthetics (numbing medicine) like Lidocaine or Bupivacaine. We do use steroids (Cortisone, Depo-Medrol) but only in rare cases.

b. Can local anesthetic treat inflamation?

Accumulating data suggest that local anesthetics possess a wide range of anti-inflammatory actions through their effects on cells of the immune system. The potent anti-inflammatory properties of local anesthetics, superior in several aspects to traditional anti-inflammatory agents of the NSAID and steroid groups and with fewer side-effects, has prompted clinicians to introduce them in the treatment of various inflammation-related conditions and diseases. (Cassuto J, et al "Anti-inflammatory properties of local anesthetics and their present and potential clinical implications." Acta Anaesthesiol Scand. 2006 Mar;50(3):265-82). Pecher S, et al., are also pointed out on potent antiinflammatory activity of local anesthetics (Anaesthesist. 2004 Apr;53(4):316-25)

Study by Pietruck C, et al demonstrated anti-inflammatory effects of lidocaine and bupivacaine at concentrations smaller than used clinically. (Anesth Analg. 2003 May;96(5):1397-402)

Results of study by Fischer LG, et al., explains the antiinflammatory effect of local anesthetics by suppression of chemotaxis of human neutrophils. (Anesth Analg. 2001 Apr;92(4):1041-7)

c. MRI or Nerve Blockade? Which method more accurate for diagnosis?

There are often findings on an MRI that may be irrelevant to the patient's pain. The New England Journal of Medicine published a MRI study where they looked at asymptomatic volunteers who specifically denied any history of back pain. Each of these volunteers had a lumbo-sacral MRI. (Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.) The number who had abnormalities on MRI was dramatic -- at age 60 the incidence of disc degenerative disease (disc bulging, herniation) was about 92%. In another sample, 40% of volunteers at age 35 had evidence of herniated lumbar disc. We have to be very careful when interpreting those abnormalities on MRI as being the cause of back pain, since these findings may be unrelated to the reason for their present pain. From another hand if we can numb a specific nerve (nerve blockade) under X-ray and make pain go away temporary, it will help us more accurately diagnose the source of pain.

d. Does epidural injection can be done in different way?

The success of the injection depends on the technique that is used. The traditional epidural injection technique involves the doctor feeling the patient's spine in order to guide the placement of a needle between the spinal vertebrae. A newer technique involves using x-ray fluoroscopy to guide the needle directly to the neural foramen, the point where the affected spinal nerve root exits the spine. This technique increases the success of the procedure. Study in the Archives of Physical Medicine & Rehabilitation showed that 75% of the 69 patients treated with these more precisely placed injections demonstrated good long-term benefit.

e. Does epidural injection can be done in different way?

Steroids offer no benefit compared with bupivacaine alone in epidural injection for chronic leg pain, according to the results of a randomized double-blind trial published in Journal Spine (Spine. 2005;30:857-862). Recently a guideline developed by the American Academy of Neurology finds epidural steroid injections play a limited role in providing short-term pain relief for lower back pain that radiates down a leg, and do not provide long-term pain relief. The guideline is published in the March 6, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.

f. Is steroid really necessary for success of epidural injection?

Steroids offer no benefit compared with bupivacaine alone in epidural injection for chronic leg pain, according to the results of a randomized double-blind trial published in Journal Spine (Spine. 2005;30:857-862). Recently a guideline developed by the American Academy of Neurology finds epidural steroid injections play a limited role in providing short-term pain relief for lower back pain that radiates down a leg, and do not provide long-term pain relief. The guideline is published in the March 6, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.