Epidural Steroid Injections: What to Expect

Living with chronic back or neck pain can disrupt every part of your life—from sleep and mobility to work and overall well-being. For many individuals with conditions like herniated discs, spinal stenosis, or sciatica, epidural steroid injections (ESIs) can offer a minimally invasive option for pain relief and improved function. If you’re considering or have been recommended an ESI, understanding the procedure, benefits, and potential outcomes can help you feel more informed and empowered.

What Are Epidural Steroid Injections?

An epidural steroid injection is a procedure in which a corticosteroid, often combined with a local anesthetic, is injected into the epidural space of the spine. This area surrounds the spinal cord and nerves, where inflammation can lead to pain that radiates into the arms or legs.

These injections are not a cure, but they can significantly reduce inflammation and pain, allowing patients to participate more effectively in physical therapy or other rehabilitation efforts.

Who Are Good Candidates for ESIs?

You may be a candidate for epidural steroid injections if you suffer from:

• Herniated or bulging discs

• Degenerative disc disease

• Spinal stenosis (narrowing of the spinal canal)

• Sciatica

• Radiculopathy (nerve root irritation)

• Post-surgical back pain

Generally, these injections are considered when conservative treatments like physical therapy, medications, or chiropractic care have not provided sufficient relief.

How to Prepare for Your Procedure

Before undergoing an ESI, your healthcare provider will usually perform diagnostic imaging (like an MRI or CT scan) to locate the exact source of nerve irritation. You’ll also be asked about any allergies, especially to contrast dye or anesthetics, and current medications.

In the days leading up to your injection, you may be instructed to:

• Avoid blood-thinning medications (under your doctor’s guidance)

• Refrain from eating or drinking a few hours before the procedure

• Arrange for transportation home, as some sedation may be used

What Happens During the Procedure?

The procedure typically takes 15 to 30 minutes and is performed in an outpatient setting, such as a hospital radiology suite or a pain management clinic.

Here’s what you can expect:

1. Positioning: You will lie face down on a table, sometimes with a pillow under your abdomen for spinal alignment.

2. Sterilization: The skin over the injection site is cleaned and sterilized.

3. Local Anesthesia: A small amount of local anesthetic numbs the area to minimize discomfort.

4. Needle Placement: Using fluoroscopy (real-time X-ray) or ultrasound guidance, your provider will carefully insert a needle into the epidural space.

5. Injection: A corticosteroid solution, sometimes mixed with a local anesthetic, is slowly injected.

6. Monitoring: You’ll be monitored briefly afterward to ensure no immediate adverse reactions.

The actual injection is often described as mildly uncomfortable, with pressure rather than sharp pain. Most patients tolerate it well.

What to Expect After the Injection

After the procedure, you’ll rest for a short period under observation. While many patients can walk out shortly after, you may feel:

• Mild soreness at the injection site

• Temporary numbness or weakness in the legs (due to the anesthetic)

• Symptom flare-up within the first 24–48 hours as the steroid begins to work

Pain relief may begin within a few days, but it can take up to a week for full effect. Results vary—some people experience weeks or months of relief, while others may need additional injections.

Benefits of Epidural Steroid Injections

• Targeted pain relief for spine-related conditions

• Minimally invasive and performed on an outpatient basis

• Enables physical therapy by reducing pain and improving mobility

• Can delay or eliminate need for surgery

These injections are often part of a broader treatment plan that may include physical rehabilitation, ergonomic changes, or lifestyle modifications.

How Long Do the Effects Last?

The duration of relief varies widely based on the underlying condition and individual response. Some patients report improvement for several months, while others may need a series of injections spaced weeks apart. Most providers limit the number of injections to 3-4 per year to avoid long-term steroid side effects.

Are There Risks or Side Effects?

While generally safe, ESIs do carry some risks:

• Infection (rare, but possible)

• Bleeding or hematoma

• Nerve damage (very rare)

• Headache or nausea

• Elevated blood sugar or blood pressure temporarily after injection

• Allergic reaction to medication or contrast dye

Always discuss your full medical history, including past reactions to steroids or anesthetics, with your provider.

When to Contact Your Provider

You should contact your healthcare team immediately if you experience:

• Severe back pain or worsening symptoms

• Fever, chills, or signs of infection

• Loss of bladder or bowel control

• Numbness or weakness that does not resolve

These may indicate a complication that requires prompt medical attention.

Integrating ESIs Into a Comprehensive Pain Management Plan

Epidural steroid injections are not a standalone solution. They work best when integrated into a comprehensive approach that may include:

• Physical therapy

• Anti-inflammatory medications

• Posture correction and ergonomic adjustments

• Weight management

• Stretching and strengthening exercises

By reducing inflammation and pain, ESIs often enable patients to actively participate in rehab and avoid more invasive procedures.

Conclusion

Epidural steroid injections offer a valuable tool in managing spine-related pain, especially for conditions involving nerve compression or inflammation. While not a cure, they can provide significant relief, restore function, and improve quality of life when other methods fall short.

If chronic back, neck, or leg pain is impacting your daily life, speak with your physician or a pain specialist to determine if an epidural steroid injection is right for you.