In modern society, one would be hard–pressed to overestimate the impact of low back pain (LBP). The cost of this problem in terms of human suffering and dollars is staggering. For instance, it is estimated that between 70 and 80 percent of all adults will experience LBP during their lifetime and that, at any given time, 30 percent of the population will be afflicted in some way. Apart from the common cold, it remains the number one reason for worker absenteeism in the U.S.A. and most other countries in the industrialized world. Likewise, the disabling effects of LBP make it the greatest cost in workers compensation. The economic cost from all of this is estimated at 90 to 100 billion annually, not to mention the physical, emotional, and psychological impact it will have on those who suffer with LBP.

Where does all this back pain come from, and who are the people most at risk? Surprisingly, the ratio between men and women is about equal. However, in younger patients the incidence is disproportionately male, while females report more LBP after 60 years of age. For both sexes, the incidence increases with age.

Many studies have shown an association between LBP and poor general health. Obesity (and possibly excessive height), smoking, low levels of physical activity, and poor strength and flexibility all predispose people to LBP. And, not surprisingly, jobs involving heavy physical labor, and participation in certain sports such as wrestling and gymnastics, have likewise been associated with back pain.

Several common conditions have been identified that can cause severe acute or chronic back pain and/or leg pain (sciatica). Some of these causes have been identified as herniated disc (#1), degenerative disc disease, spinal stenosis, compression fractures, expanding synovial cysts, etc, These conditions often lead to the impingement or entrapment of a nerve causing irritation and inflammation that will lead to perceived pain. Unfortunately, in the majority of cases a definitive diagnosis is never given. Therefore, it has been said that “back pain is an illness in search of a disease.

As discouraging as that may seem, there are a number of conventional, as well as, non-conventional interventions that offer hope for the individual who is suffering from LBP. These interventions can range from something as simple as hydrotherapy and extend all the way to include surgery if necessary.

One common treatment option that is used for many forms of LBP and leg pain – radiating down one or both legs - is lumbar epidural steroid injections (LESI’s). They have been used in this manner since 1952 and remain an integral part of the non-surgical management of both, LBP and sciatica. This pain management intervention is now available by referral at Wallowa Memorial Hospital through the anesthesia department.

What is an LESI, and how do they work? Well, many of you have heard of epidurals being used for the treatment of pain in the obstetric patient about to be delivered. A LESI is essentially performed in much the same manner. The patient is generally placed in the seated position with there lower back exposed. The site of the injection is then identified and prepared with a topical anti-infectant. Next, a local anesthetic is used to numb the skin at the point of the epidural injection. This injection is designed to deliver a steroid medication directly (or very near) the source of pain generation. In contrast, oral steroids and painkillers have a dispersed, less-focused impact and may have unacceptable side effects. Additionally, since the vast majority of pain is the result of chemicals produced by your body in response to the irritation and inflammation of nerves and mechanical structures in your back, a small amount of diluted local anesthetic and/or saline may also be injected to “flush out” these chemicals that may be contributing to the pain.

This is an outpatient procedure and will, generally, take only 15 to 30 minuets to perform. Following the injection, you will be monitored for an additional 15 to 20 minuets before being discharged. Patients are usually asked to rest the remainder of the day before resuming their normal activities the following day. Tenderness at the injection site, or a temporary increase in pain, has been reported during the first 24 to 48 hours. Both can be treated effectively with ice packs the first 24 hours if needed.

Most practitioners will agree that, while the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program. If the initial injection is effective for a patient, he or she may have up to three in a one-year period. Finally, if you are frustrated and discouraged by back pain and nothing seems to be working to alleviate the pain, consult with your local physicians to see whether a LESI is an option for you.

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• Lumbar Epidural Steriod Injections - Low Back Pain