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What Causes Severe Pain In The Thigh After Receiving Epidural Steroid Injection?

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Posted on Fri, 9 Jun 2017
Question: Hi my husband had an es1 2days ago he di well with it no adverse reaction, but is now having pain on the left side of his left thigh he is unable to bare any weight on his left leg with out a pain level of about 9.

Do u have an answer yet thank you>
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Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

It might have been useful if you provided some more information on why did he have the injection (I am assuming by ESI you mean epidural steroid injection). What were his symptoms, did he have imaging and what did it show.

Epidural steroid injection doesn't always work, it is effective in only about half of the patients, in many others unfortunately it is not of much help. In that case depending on imaging results and the time course of the symptoms surgery may be considered.

One might worry about the current pain being a consequence of the ESI, it may cause direct nerve damage from the needle. However that usually starts during the procedure so since for the first 2 days he was feeling well shouldn't be the case. Similarly for local bleeding it shouldn't start suddenly after 2 days, should appear earlier. There is also the risk of infection at the site, but usually there are local changes like swelling, redness, increased local temerature, local tenderness, fever etc, and also it should develop more gradually not as suddenly as you seem to indicate. So not likely to be the case of a procedure complication.

It is much more likely for the pain to be in the setting of the primary issue the ESI was performed for, worsening of the nerve compression (usually due to disc herniation). Given the pain scale you describe and the acute worsening I suggest he should be evaluated urgently (even in the ER if you can't get an early appointment) for other symptoms such as muscle weakness, abnormal reflexes, bladder control issues which might indicate severe compression of the nerves and might even warrant urgent imaging and surgery. It would also serve to check on the puncture site and confirm there is no sign of infection. If not such issues are found then pain treatment should be continued. Depending on how long the symptoms have been present surgery should again be considered but on a less urgent basis.

I remain at your disposal for other question.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

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What Causes Severe Pain In The Thigh After Receiving Epidural Steroid Injection?

Brief Answer: Read below Detailed Answer: I read your question carefully and I understand your concern. It might have been useful if you provided some more information on why did he have the injection (I am assuming by ESI you mean epidural steroid injection). What were his symptoms, did he have imaging and what did it show. Epidural steroid injection doesn't always work, it is effective in only about half of the patients, in many others unfortunately it is not of much help. In that case depending on imaging results and the time course of the symptoms surgery may be considered. One might worry about the current pain being a consequence of the ESI, it may cause direct nerve damage from the needle. However that usually starts during the procedure so since for the first 2 days he was feeling well shouldn't be the case. Similarly for local bleeding it shouldn't start suddenly after 2 days, should appear earlier. There is also the risk of infection at the site, but usually there are local changes like swelling, redness, increased local temerature, local tenderness, fever etc, and also it should develop more gradually not as suddenly as you seem to indicate. So not likely to be the case of a procedure complication. It is much more likely for the pain to be in the setting of the primary issue the ESI was performed for, worsening of the nerve compression (usually due to disc herniation). Given the pain scale you describe and the acute worsening I suggest he should be evaluated urgently (even in the ER if you can't get an early appointment) for other symptoms such as muscle weakness, abnormal reflexes, bladder control issues which might indicate severe compression of the nerves and might even warrant urgent imaging and surgery. It would also serve to check on the puncture site and confirm there is no sign of infection. If not such issues are found then pain treatment should be continued. Depending on how long the symptoms have been present surgery should again be considered but on a less urgent basis. I remain at your disposal for other question.