High dosages of oral corticosteroids taken daily for prolonged periods of time can have serious systemic side effects including bone loss ( osteoporosis), increased risk of infections and diabetes and cataracts, thinning of skin, stretch marks, increased facial/body hair growth, acne, fluid retention, weight gain with redistribution of fat (fat deposits on back and face, thinning of limbs), muscle weakness, decreased resistance to infections, stomach ulcers, mood swings, insomnia, suppression of the body's own production of cortisol, etc.
Epidural steroid injections also pose a risk for a spinal headache, weakness, and increased pain. A spinal headache is a headache that gets worse when you sit up. It usually improves in 1-2 days with lying down flat, drinking water and taking caffeine. Occasionally, a persistent spinal headache must be treated with a blood patch. Please contact the office if you have a persistent spinal headache. If you develop weakness after an epidural steroid injection, it usually improves in 4-5 hours as the local anesthetic wears off. If you develop increased pain after the injection, it should improve in 2-3 days as the effect from the steroid starts working, and the injected fluid dissipates.
The procedure is generally safe. However, with any procedure or medications there are potential risk, complications, and side effects. The potential risks to a certain degree depend on the region of the epidural. Whenever a needle is introduced through the skin there is risk of infection, bleeding, and soreness. For this reason, all our procedures are performed under sterile technique, and a careful history is taken to ensure any risks of bleeding are minimized. On occasion, one may develop numbness do to extensive spread of the local anesthetic. Rarely, an individual can develop a “spinal headache,” this typically occurs 1% of the time. And is more common in younger individuals. Bleeding into the spinal canal on extremely rare occasions can occur. This is referred to as an “epidural hematoma;” this is why it is essential for you to make us aware of any blood thinner medications you are taking; as this can lead to spinal cord and nerve damage. Recently, the FDA issued a black box warning on epidural steroid injections. Please see Informed Consent Documents for further information on this warning. All complications are extremely rare.