Sciatica pain from a pinched nerve can be exceptionally painful. Pain Management treatments available to help the pain from a lumbar herniated disk include physical therapy, pain medication, spinal decompression treatment, chiropractic treatment, and epidural steroid injections.
When a nerve is pinched from a piece of disc that has herniated (slipped disc), the pressure from the disc is not painful by itself. The pressure sparks up an inflammation process, which produces mediators including interleukins, prostaglandins, and cytokines which surround the nerve root and that is what causes pain.
So the theory behind an epidural steroid injection for a lumbar disc herniation is to provide the anti-inflammatory substance to alleviate pain. Pain doctors typically inject a steroid medication under fluoroscopy (x-ray) guidance. The steroid medication is place around the pinched nerve root, bathing the area with an extremely potent anti-inflammatory material. The steroid medication is cortisone, and comes in various brand names such as Kenalog, Depo-Medrol, Celestone, and others.
The various types of steroids have different qualities with respect to what’s called particulate matter. the larger the particulate matter, the longer the steroid bathes the nerve root as it takes longer to dissolve.
Injecting steroids around the pinched nerve root can be very effective for sciatica pain, but it does not correct the herniated disc. It does not dissolve the lumbar disc herniation, it merely provides temporary pain relief for a few days, weeks, or months. The hope is that pain relief will be provided while one’s own body dissolves the piece of disc herniation that is pressing on the nerve root. If that does not happen before the relief from the epidural steroid injection wears off, then the spinal injection can be repeated.