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Epidural Blocks & Trigger Point Injections

At A Glance

  • The epidural block is one of the most common pain management procedures, in which a specialist injects a mixture of medicines into the epidural space, the outermost part of the spinal canal and location of the spinal nerves and spinal cord.
  • The epidural block, or “epidural,” as it’s commonly known, attempts to treat the symptoms of an underlying problem but not the problem itself.
  • Similar procedures include the caudal-epidural, transforaminal epidural, and the trigger point injection.



The epidural block is often an alternative to more invasive surgical procedures. A pain-management specialist (such as an anesthesiologist or a physiatrist, or doctors specially trained in treating pain) performs the procedure under sterile conditions using television x-ray known as fluoroscopy. This technology helps ensure placement of the needle is in the exact location so that a mixture of numbing medicine, cortisone, and sometimes such pain medication as morphine can take effect.

The procedure is most effective for degenerative or arthritic inflammatory conditions and pinched nerve or sciatic pain. In general, the success rate is around 60 to 70 percent, depending on the problem being treated.

Essentially, an epidural buys time while Mother Nature tries to correct the underlying problem. Most pain management physicians will not do more than three of these injections in one year due to potential problems and complications associated with too much cortisone use. The procedure has the tendency to be abused, especially if it is not helping.

Epidurals treat Herniated Intervertebral Disc, Degenerative Disc Disease, Spondylolisthesis, Facet Arthritis and Spinal Stenosis.

Caudal Epidural

The same criteria, indications, medications, results and cautions apply to the caudal epidural as to the standard epidural block.
The procedure is similar to the epidural, except a pain-management specialists performs the injection very low in the spine at a location called the sacral hiatus, placing the needle in a small opening just above the tail bone between the butt cheeks.

The caudal epidural works best for problems involving the lower lumbar spine, especially the L5/S1 disc level. This procedure used to be called a “saddle block.”

Caudal Epidural treats Herniated Intervertebral DiscDegenerative Disc DiseaseFacet Arthritis and Spinal Stenosis.

Transforaminal Epidural

This injection differs from the standard epidural in that access to the epidural space is gained through the foraminal canal, the space formed by the vertebrae above and below where an individual spinal nerve exits the spinal canal.

The transforaminal epidural is more difficult but allows for more accurate placement of the needle and medication into an area that otherwise may be difficult or impossible to enter. The procedure requires fluoroscopy (television x-ray) and special long needles to gain access to the proper area to be treated.

The transforaminal epidural treats Herniated Intervertebral DiscSpondylolisthesisFacet Arthritis and Spinal Stenosis.

Trigger Point Injections

In a trigger point injection, a doctor delivers a numbing, cortisone-type medication into a painful area of knotted muscle.

Trigger points often irritate surrounding nerves and cause pain felt in another part of the body – this phenomenon is also known as referred pain. When successful, a TPI inactivates the trigger point and reduces pain, swelling, and associated inflammation, thereby helping to prevent the pain from coming back.

A TPI can be given at a single or multiple anatomical sites. Repeat injections may be necessary. A trigger point injection treats Sprains and Strains.

Frequently Asked Questions

How does an epidural work?
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