July 28

Epidural Injections for People with Back Pain

Nearly 65 million Americans report having had a recent episode of back pain, while 16 million adults (8% of all adults) suffer from persistent or chronic back pain and are limited from everyday activities.

If you’re part of that huge group of people with back pain, you know how frustrating and debilitating it can be to try everything to alleviate the pain — and have nothing work.

If you deal with constant nerve pain in your spine, your doctor may recommend that you get an epidural steroid injection. In this article, we’ll cover everything you need to know to be well-prepared for the procedure.

Types of Back Pain

There are several different types of back pain, and an epidural steroid injection isn’t used for all of them. Different pack pains include:

Getting an epidural steroid injection is most commonly used for back pain that comes from a herniated disc, sciatica pain, spinal stenosis, degenerative spine disease, or bone spurs.

There is a wide range of causes of back pain, including:

  • Age
  • Lack of exercise
  • Smoking
  • Psychological conditions
  • Improper lifting
  • Diseases
  • Excess weight

Make sure to see a doctor to find out the root cause and type of your back pain and if an epidural steroid injection is right for you.

A man with back preparing for an Epidural Steroid Injection

What is an Epidural Steroid Injection?

An epidural steroid injection consists of a shot of cortisone. It is injected into the outer part of the spinal column, called the epidural space.

Cortisone is a naturally-occurring steroid in the human body. It is usually a chemical response that our brain produces when we feel stress. When it is released from the adrenal gland, cortisone suppresses the immune system, which lowers inflammation and our perception of the pain.

The cortisone that our body produces is relatively short-lived. Artificial cortisone that is given in an epidural steroid injection, on the other hand, lasts much longer. It can last anywhere from a few weeks to a few months.

How Does It Work?

To understand how an epidural steroid injection works, it’s important to first understand our immune system.

You can think of your immune system as the body’s built-in defense system. Whenever your body is attacked by bacteria, viruses, or any other foreign invaders, your immune system fires up to protect you.

The first tool that the immune system uses is inflammation. This kills off bacteria around the afflicted area before it moves on to the next step.

However, your body isn’t meant to stay inflamed for a long period of time. It is just a temporary defense mechanism that your immune system uses. If you stay inflamed for long periods of time, it can become painful.

Cortisone that is released by the adrenal gland, on the other hand, has the opposite effect. It suppresses the immune system in a particular area and reduces inflammation as well as the pain that is associated with it.

When you get an epidural steroid injection, you take advantage of this naturally-occurring process. By injecting artificial cortisone into your back, it holds back pain for a longer period of time.

Facet joint injection, therapy against backbone injury or pain. Close-up of vertebrae with a syringe isolated on a white background 3D rendering illustration. Medical and healthcare, anatomy, medicine concept.

Are There Different Methods of Epidural Injections?

There are three different methods that doctors use to inject the steroid into the spine: caudal, interlaminar, or transforaminal.

A caudal injection is the least complicated way to inject the steroid into the epidural space, but it is also the least specific. It is useful in situations where there is pain in different spots in the spine.

An interlaminar injection injects the epidural directly into the epidural space on the affected level and can target one side or the other.

A transforaminal injection delivers the medication where the specific nerve root exits the spine and is compressed by the disc herniation. It is typically the top choice for an epidural injection.

How Long Does an Epidural Injection Last For People With Back Pain?

The epidural injection should start to relieve the pain in your back within 1 to 3 days, but it can take up to a week for some people.

It’s important to note that epidural injections aren’t a cure for back pain, although some people have reported getting permanent relief. If you suffer from chronic back pain, the pain relief typically lasts for around 3 to 6 months.

This means that if the pain returns, you may need to get more than one injection a year. It can be administered three to six times a year. If you experience a new disc herniation, they might suggest injections that are only weeks apart.

What to Expect From Your Epidural

If you plan on getting an epidural soon, it might help to understand what you should expect in the coming days. Here’s an example of what will happen.

Before the Procedure

Your doctor will ask you about your medical history, current medications, and allergies. They’ll go through all of the potential risks that are associated with the injection (see below).

Make sure to inform your doctor if you are pregnant, plan to be pregnant, or are nursing.

After the procedure, you won’t be able to drive, so you should arrange to have someone pick you up and drive you back. They’ll tell you to wear comfortable clothing and bring something to do to occupy your time while you wait to have your procedure done.

During the Procedure

The nurse attending the procedure will clean the skin around the injection site with antiseptic. The doctor will then inject a local anesthetic to numb your skin and deeper tissues. They might also use a “cold spray” to numb the skin before placing the needle in.

Next, they’ll have you lie down on an X-ray table. Although there will be some discomfort, you shouldn’t feel too much pain. It will be more like a strong pressure on the injection site. Everyone experiences the procedure differently.

If you are nervous, you can ask the doctor for a mild sedative to help you relax before the procedure.

After the Procedure

It shouldn’t take more than a few days to a week for the epidural to take effect. Everyone is different.

If you still feel back pain after a week, your doctor will begin to investigate other possible sources of pain. If you still feel it, your doctor may suggest additional epidural injections for back pain.

To help extend the effects of the back pain treatment, consider doing the following:

  • Exercising regularly
  • Staying at a healthy weight
  • Quitting smoking

Your doctor will let you know what will help the most.

What Are the Risks and Side Effects of Epidural Injections?

Usually, epidural injections are considered safe with few ill effects. However, there can be some complications that do arise.

Some common side effects include:

  • Sleeping issues
  • Anxiety
  • Menstrual changes
  • Water retention issues
  • Increased hunger
  • Steroid flush (rise in body temperature)
  • Pain at the injection site
  • Increase in blood sugar levels
  • Headache

Most side effects clear up without treatment within a few days.

Some more serious but rare issues include:

  • Paralysis
  • Bleeding
  • Allergic reaction
  • Infection
  • Nerve damage
  • Numbness or tingling

If you experience any of these, make sure to contact a doctor.

Another possible risk is the accidental puncture of the dura mater, the tissue that surrounds the spinal cord. This can cause spinal fluid to leak into the spinal cord, which can lead to a spinal headache. This is an intense headache that worsens from standing. However, they usually don’t last for more than a couple of days.

Other Frequently Asked Questions About Epidural Injections

Still have questions? Here are some other answers to questions you may be looking for.

Do They Give You Anesthesia?

A local anesthetic will be injected into the area which will numb the area where the needle will go. Although it might be mildly uncomfortable, the procedure does not cause severe pain.

How Long Does the Procedure Last?

The procedure lasts around 10 to 20 minutes and requires the patient to lie prone. Afterward, you can sit, stand, and walk as usual.

Who Performs Epidural Steroid Injections?

Pain management physicians, physiatrists, and interventional radiologists are all trained to safely perform the procedure. They will often go through additional subspecialty fellowship training for the process as well.

Key Takeaways

Getting an epidural steroid injection is often one of the most effective ways to get relief for people with back pain.

If you think an epidural might be the best course of action for you, our board-certified pain specialists deliver some of the best patient care and dedicated attention that you’ll find.

Come request an appointment with our spine specialists today!


Chronic Pain, Common pain conditions, Minimally Invasive Treatments

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