How it works
How epidural steroid injections work
An epidural steroid injection combines a corticosteroid, which is an anti-inflammatory medicine, with a numbing medicine. It is placed in the epidural space, the area around the spinal nerves. When a nerve is swollen or irritated, it can cause pain in the back, neck, arms or legs. The steroid aims to reduce that inflammation and swelling, and the numbing medicine can ease pain.
At Lewis Pain & Physical Medicine, ESI is performed by a physician using x-ray guidance. ESI can be used in the neck (cervical), mid back (thoracic) and low back (lumbar) areas of the spine. It is meant to ease pain so you can stay active and take part in your other treatments while your body recovers from an injury.
Who may benefit
Who may be a candidate for an epidural steroid injection
Several spine problems can inflame a nerve and cause severe pain. ESI may be considered for pain from:
- Spinal stenosis, a narrowing of the spinal canal
- Spondylolysis, a stress fracture in a vertebra
- A herniated disc
- A degenerative disc
- Sciatica, pain that travels from the low back down the leg
- Injury or trauma to the spine
You may be a candidate if you have significant spine-related pain from one of these conditions and other care has not given you enough relief. Your provider will look at your history, your symptoms and your imaging, then talk with you about whether ESI makes sense.
Having one of these conditions does not by itself mean an injection is right for you.
When should you see a doctor for epidural steroid injections?
What to expect
What to expect before, during and after your injection
Before your injection
You will meet with your provider to review your history and symptoms. Tell the team about your medicines, especially blood thinners, and about any allergies. Your provider will discuss sedation options for your procedure at your visit, and your team will tell you how to prepare. If sedation is used, you will need someone to drive you home.
During the procedure
Several approaches can be used, including transforaminal, interlaminar and caudal, and your provider chooses the one that fits your needs. A needle is guided to the right spot using x-ray images. When the needle is in the right place, the steroid medicine is injected and the needle is removed.
After your injection
You will be watched for a while before you go home. You may have soreness where the needle went in. Over-the-counter pain medicine, such as acetaminophen, may help with this. Take it easy for the first 24 hours and listen to your body. Pay attention to your pain level over the next days so you and your provider can judge how the injection worked for you. Our office will follow up with you.
Do not stop or change any medicine, including a blood thinner, unless the clinician who prescribes it tells you to.
Benefits and limitations
Possible benefits and limitations
The main goal of ESI is to ease pain so you can return to normal activities and do the exercises in your care plan.
People vary a lot. Some notice relief within a few days, and others take a couple of weeks to see a difference. How long relief lasts also varies from person to person, and some people do not get the relief they hoped for.
If the effect begins to wear off, you may be eligible for more treatment, and in some cases more than one injection is needed. Your provider can give you a realistic idea of what to expect for your condition.
Risks and side effects
Risks and side effects of epidural steroid injections
Like any injection near the spine, ESI has risks. They can include bleeding, infection, nerve irritation, a temporary rise in pain or an allergic reaction to the medicine. Steroids can also have effects on blood sugar and on other parts of the body.
Please talk with your provider about the risks that apply to you before deciding.
Other options
If an injection is not the right fit
Your provider can talk with you about other options based on the cause of your pain, your goals and what you have already tried.
Common questions
Questions about epidural steroid injections
Your provider can talk through your own plan at your visit.
What are epidural steroid injections and how do they work?
An epidural steroid injection places a steroid and a numbing medicine in the epidural space around the spinal nerves. The steroid aims to reduce inflammation and swelling that irritate the nerves, and the numbing medicine can ease pain. It is used for pain in the neck, mid back or low back.
Who may be a candidate for an epidural steroid injection?
People with spine-related pain from conditions such as spinal stenosis, a herniated disc, a degenerative disc or sciatica may be candidates. ESI is often considered when other care has not given enough relief. Your provider will decide with you after reviewing your history and symptoms.
How long does the procedure take, and is it painful?
The injection itself is done with x-ray guidance, and your team will tell you how long to plan for at your visit. You may have soreness where the needle goes in. Your provider will discuss sedation options for your procedure at your visit. Afterward, you will be watched for a short time before going home.
What is recovery like, and when can I drive or go back to work?
If sedation is used, you will need someone to drive you home. Soreness at the injection site is common, and over-the-counter pain medicine may help. Take it easy for the first 24 hours; your team will tell you when you can return to work and your usual activities.
How long might the effect last?
Some people notice relief within a few days, and others take a couple of weeks. How long relief lasts varies from person to person. If it wears off, you may be eligible for more treatment.
Will I need more than one injection?
In some cases more than one injection is needed. There is no single yearly number for everyone: it depends on what your provider finds and on your insurance plan.
Clinical references
Individual results are not guaranteed and may vary from person to person. This page shares general information. It is not medical advice and does not replace a visit with a qualified clinician.