From the Guidelines
The patient should be advised to contact their healthcare provider if the sensation of "heaviness" in both legs doesn't improve within the next 1-2 days or if it worsens, as this could be a sign of a rare but serious complication, such as spinal cord infarction or nerve damage, as reported in the FDA Adverse Event Reporting System database 1. The sensation of "heaviness" in both legs following an epidural hip injection for chronic pain is a common side effect that typically resolves within a few days to a week.
- Gentle movement and walking can help improve circulation and potentially reduce the heaviness sensation.
- Avoid strenuous activities until the feeling subsides.
- This heaviness occurs because the steroid medication or local anesthetic used in the epidural injection can temporarily affect nerve function and muscle strength in the lower extremities.
- The medication may cause mild inflammation around the nerve roots before its anti-inflammatory effects take hold.
- Staying hydrated can help your body process and eliminate the medication more efficiently. If you experience any new symptoms such as severe pain, numbness, tingling, weakness that prevents walking, loss of bladder or bowel control, or fever, seek immediate medical attention as these could indicate rare but serious complications, as highlighted in the BMJ study 1. It is essential to note that the evidence on the effectiveness of epidural injections for chronic pain is moderate, and the panel was confident that these injections probably have little to no effect on pain relief 1. However, the primary concern in this scenario is the potential for serious complications, and the patient should be closely monitored and advised to seek medical attention if they experience any worsening symptoms, as recommended by the JAMA network open study 1.
From the Research
Epidural Hip Injections for Chronic Pain
- Epidural steroid injections are commonly used to manage chronic spinal pain, including lumbar radiculopathy and spinal stenosis 2, 3, 4.
- The evidence for the effectiveness of epidural steroid injections in managing chronic pain is moderate to strong for short-term relief, but limited for long-term relief 2, 3, 4.
Possible Causes of "Heaviness" in the Legs
- "Heaviness" in the legs after an epidural injection could be related to the spread of the injectate, with unilateral contrast spread potentially influencing the degree of bilateral symptom relief 5.
- Another possible cause is neural ischemia of the nerve root due to a compressive effect of the epidural infusate 6.
Management of Bilateral Lumbar Radicular Symptoms
- Interlaminar epidural steroid injections using a parasagittal approach may result in unilateral contrast spread, which can influence the degree of bilateral symptom relief 5.
- The evidence for the use of epidural steroid injections in managing bilateral lumbar radicular symptoms is moderate, with some studies suggesting a positive effect on short-term pain and disability 3, 4.
Considerations for Future Treatment
- The choice of injection technique, including the approach and the use of contrast, may influence the outcome of epidural steroid injections 5, 4.
- The use of epidural steroid injections should be tailored to individual response, rather than a set series, and serious complications are rare if proper precautions are taken 4.