• Brian T Gegel, John P Floyd, David W Hart, W Keith Barnhill, and John P Maye.
• is the CEO of Gegel Anesthesia, PC, a veteran owned and operated anesthesia services provider in San Antonio, Texas. He is a recent graduate of and adjunct faculty with the University of South Florida Simulation-Based Academic Fellowship in Advanced Pain Management, Tampa, Florida.
• AANA J. 2019 Feb 1; 87 (1): 71-79.

AbstractThe Institute of Medicine has reported that greater than 115 million adults in the United States are living with some form of chronic pain. Back pain is the most prevalent and is associated with high individual morbidity and increased healthcare costs. One approach for the management of chronic back pain involves the injection of corticosteroids in the epidural space.This interventional approach requires advanced training with techniques that vary according to the level of the vertebral column where the injection is to be performed. The primary rationale for epidural steroid injection is to reduce the inflammation surrounding the spinal nerve root as it exits the neuroforamen.Injections are performed at levels that correspond most appropriately with the patient's clinical presentation,physical findings, and radiographic findings. Epidural steroid injections are considered safe and effective, and are supported by evidence for the treatment of radicular pain. Complications from epidural steroid injections are rare but can be catastrophic, including permanent disability and death. The focus of this article is to understand how technique and selection of specific corticosteroids used for epidural injection can manage chronic back and radicular pain effectively while minimizing risk that leads to unnecessary harm.Copyright© by the American Association of Nurse Anesthetists.

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