• Reference Number: HEY-674/2023
• Departments: Pain Medicine
• Last Updated: 1 March 2023

Introduction

This leaflet has been produced to give you general information following your discharge from your pain treatment. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

This treatment is intended to help you manage your pain, it is not a cure for your condition.

Consent – should be informed, you need to be aware of the potential risks and side effects associated with your procedure. These will be discussed with you by your consultant before you consent to your treatment. Your consultant will be happy to answer any questions you may have regarding your treatment – so please ask if you are unsure about anything.

• Procedure may fail/may not work
• May experience permanent nerve damage, the risk of this happening is rare, estimated to be 0.235% or 1 in 23,500 patients (Royal College of Anaesthetists 2017)
• Infection
• Bleeding/bruising
• Numbness/weakness in legs/arms depending on where your injection sites are
• Use of a steroid injection during your procedure can cause a lowering of your immunity making you more susceptible to infection and COVID 19. You may also experience short term effects such as facial flushing, an increase in blood pressure and an increase in blood sugar levels for a few days if you have diabetes.

For the next 24 hours you are advised:

• Not to drive your car. Your insurance is void if you ignore medical advice.
• If you have had sedation, you are advised not to operate machinery, drink alcohol or sign legally binding documents.
• To take all your medication as normal.
• To eat and drink normally.
• To be prepared to take the next day off work depending on how you feel.

What to expect after your procedure

• Avoid showering for 24 hours after your procedure, keep the injection sites clean and dry. If you have a dressing it can be removed after 24 hours.
• Your skin may be a different colour around injection sites, this is due to the preparation used to clean your skin to minimise the risk of infection. It should disappear when you get washed.
• You may experience some numbness/weakness in your leg(s) or arm(s) after your procedure, depending on where your injection sites are. This is because local anaesthetic has been injected around the nerves during your procedure, to help relieve your pain, rarely this can spread causing numbness/weakness in the affected area. This should wear off within a day or two, please do not get up/walk without assistance until you have regained all sensation in your legs.
• If you have had a caudal epidural you will need to pass urine before you can be discharged home to test your bladder control. This is because the local anaesthetic used during the procedure can affect the surrounding nerves, so you may not know when your bladder is full.
• You may experience more pain initially after your procedure, this is not unusual. The steroid injection can irritate the affected nerve and cause an increase in pain, this may take a week or so to settle down. The steroid may take a couple of days or up to a couple of months to fully take effect. Once effective it will hopefully provide pain relief for many months.
• If your treatment involves radiofrequency ablation, where heat is applied through specialised needles, to small areas of nerve tissue, to temporarily stop their ability to send pain messages to the brain. You may experience some cramping in your legs afterwards, this is due to the nerve contracting. Usually this can be helped by taking anti-inflammatory medication and application of heat to the affected area.

*Any swelling, tenderness or redness in your calf should be checked by your GP to rule out deep vein thrombosis*

What to do if you experience any problems after your procedure

For general non urgent problems contact the pain service TEL 478868, you will be asked to provide your name, date of birth and NHS or HEY hospital number which can be found at the top on your discharge letter. Messages will be forwarded to the Pain Management Nurses who will call you back usually within 24-48 hours.

If you notice any pain, swelling or bleeding around injection sites, if you feel unwell with a fever/chills, you may have an infection and should see your GP as soon as possible.

Cauda Equina Syndrome

The Cauda Equina is a collection of nerves in the lumbar and sacral region of your back. A rare but serious condition called Cauda Equina Syndrome can occur after injections around your lower back which can lead to permanent damage or disability. If you experience any of the following symptoms you should attend your local Urgent Care Centre/A&E for medical assessment without delay.

• Loss of feeling/pins and needles between your inner thighs or genitals
• Numbness in or around your back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increased difficulty when you try to pass urine
• Loss of sensation when you pass urine
• Leaking urine or recent need to use pads
• Not knowing when your bladder is either full or empty
• Inability to stop a bowel movement or leaking
• Loss of sensation when you pass a bowel motion
• Change in ability to achieve an erection or ejaculate

Pain Diary

The follow up appointment after your procedure will be either a telephone review with a pain management nurse, or a clinic review with your consultant, who will need to know your pain scores pre and post procedure.

During your admission, the nurse will give you a pain diary to fill in at home. You will be asked to score your pain between 0 and 10 (0 being no pain and 10 the worst pain) before you have any treatment, this is used as a baseline score.

The next score is to be completed 24 hours after your procedure*, this is recorded as a percentage 0% = no pain relief → 100% being completely comfortable/pain free.

*if you have had a diagnostic medial branch block you need to record any time your pain improved as a percentage, within the first 24 hours even if it was for a short time. Your follow up is usually a 2-3 week telephone review with a pain management specialist nurse.

The third score is to be completed at 4 weeks after your procedure, again as a percentage.

The final score should be recorded at 6 weeks or time of review, between 0 – 10.

By filling in your pain diary as requested it helps at your follow up appointment by giving an accurate account of your pain and the effectiveness of the procedure. Your pain scores may determine future treatment so it is important to complete your pain diary and have it to hand at the time of your review.

Pain management advice

Pain, particularly long term or chronic pain can be associated with feelings of anxiety and depression. It is important to recognise these feelings.

Recommendations

• Socialise, keep in touch with friends and family, join a club, and take up a new hobby or course. You may find some new friends along the way.
• Concentrate on activities that you can do rather than those you find difficult, for example, watching TV, reading a book or listening to music can provide a distraction and help to improve your mood.
• Download mindfulness apps e.g. Headspace or Velindre to your phone to learn breathing and relaxation techniques which can help to reduce feelings of anxiety.
• Think about ways to improve your overall health, for example if you are overweight consider a weight loss programme/diet.

Stay Active

• It is important that any activity is something that you enjoy doing and are motivated to continue with long term.
• Walking, cycling or swimming can be helpful in improving core strength which can help in the long term management of your pain.
• Yoga, Pilates and walking in water are all low impact forms of exercise, which can improve your flexibility and core strength.
• Any exercise is better than no exercise, from a walk around your garden to a 5K hike, exercise has been shown to boost the release of endorphins which are your “happy hormones”.

 And finally……Pacing

• It is important to remember to pace your activities. This means not doing a lot in one go, but splitting activities into smaller more manageable jobs, take your time and remember to take a break before you really need one.

For further advice regarding pain management, search for www.paintoolkit.org  which contains useful information to help you manage your pain and contact details of other organisations that may be of benefit to you. Download the App from the Apple Store or Google Play Store.

The NHS website contains free exercise tutorials covering everything from belly dancing to Pilates and Yoga, just go to www.nhs.uk  → AtoZ → Fitness Studio Exercise Videos.

Additional Information

The information in this leaflet is not intended to replace the advice given to you by your GP or the pain service looking after you. If you require more information or have any questions, please speak to your GP or the Pain Service who are looking after you.

This leaflet was produced by the Centre for Pain Medicine, Castle Hill Hospital Hull and East Yorkshire Hospitals NHS Trusts and will be reviewed in January 2026

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.