Epidural Steroid Injection

If you have been offered an epidural steroid injection, it is normal to feel unsure or even worried about what it involves. This article explains the procedure in clear, honest language so you can understand your options and make informed decisions together with your healthcare team.

1. What Is an Epidural Steroid Injection?

An epidural steroid injection (often shortened to ESI) is a procedure where anti-inflammatory medicine is injected into the space around the spinal nerves, called the epidural space. This space lies just outside the sac of fluid that surrounds your spinal cord and nerves.

The injection usually contains two main ingredients:

A corticosteroid (a strong anti-inflammatory medicine)
Sometimes a local anaesthetic (numbing medicine) that works quickly but wears off within a few hours

The aim of the injection is to reduce inflammation and irritation around the affected nerves, which can ease pain, tingling, and numbness. It does not repair worn discs, fix arthritis, or permanently cure the underlying spinal problem. Instead, it can give a period of reduced pain so you can move more easily, sleep better, and take part in physiotherapy or exercise.

2. Why Might You Be Offered One?

ESIs are mainly used to treat nerve-related pain coming from the spine. This type of pain is often sharp, burning, or shooting, and may travel down an arm or leg. Common reasons your team might suggest an epidural steroid injection include:

Sciatica / lumbar radiculopathy – nerve pain running from the lower back into the buttock, leg, or foot
Cervical radiculopathy – nerve pain running from the neck into the shoulder, arm, or hand
Spinal stenosis – narrowing around the spinal nerves that can cause pain, heaviness, or weakness in the legs when walking or standing
Disc herniation (slipped disc) – where part of a disc presses on a nerve root
Post-herpetic neuralgia affecting the spine – ongoing nerve pain after shingles in the area of the spine

It is important to know that epidural steroid injections are not usually offered for “pure” mechanical back or neck pain (for example, aching in the back without pain running into the leg or arm). The evidence is stronger when the main problem is nerve pain rather than local back pain alone.

3. Types of Epidural Steroid Injection

There are three main ways to place the needle into the epidural space. Your pain specialist will choose the approach that best matches your symptoms and scan findings.

Interlaminar epidural injection

With an interlaminar injection, the needle is placed in the middle of the back between two bones of the spine (the vertebrae). The medicine is injected into the epidural space so it can spread more broadly over several nerve roots.

This approach is often used when pain affects both sides, more than one level, or when a wider spread of the steroid is desired.

Transforaminal epidural injection

With a transforaminal injection, the needle is guided to the opening where the nerve leaves the spine, called the foramen. The medicine is then delivered very close to a specific nerve root.

This approach is usually more targeted and is often preferred when one particular nerve or one side (left or right) is clearly causing the symptoms.

Caudal epidural injection

With a caudal epidural, the needle is inserted at the base of the spine through a small opening in the bone called the sacral hiatus. The medication then travels upwards in the epidural space to bathe the lower lumbar and sacral nerves.

This method is often used for pain coming from the lower part of the lumbar spine or the sacral nerves, and in some people it can be technically easier or safer than other approaches.

4. What Happens on the Day?

Epidural steroid injections are usually done as a day-case outpatient procedure. You come in, have the injection, rest for a short while, and go home the same day. The procedure itself usually takes around 15–30 minutes.

Although details vary slightly between hospitals, a typical visit looks like this:

Arrival and checks – You will be checked in, asked about your medical history, medicines, and allergies, and have basic observations such as blood pressure recorded.
Consent – The doctor will explain the procedure, benefits, and risks, and answer your questions. You will be asked to sign a consent form.
Positioning – You are usually asked to lie face down on a table. For some injections, such as in the neck or for caudal epidurals, you may lie on your side in a curled position.
Skin cleaning – The skin over the injection area is cleaned with an antiseptic solution to reduce the risk of infection.
Local anaesthetic – A small needle is used to inject numbing medicine into the skin and deeper tissues. This stings or burns briefly, then the area becomes numb.
Imaging guidance – The doctor will usually use X-ray (fluoroscopy) or sometimes ultrasound to guide the needle safely into the right position.
Contrast dye – A small amount of contrast dye may be injected so the doctor can see on the screen that the medicine will flow into the correct part of the epidural space, and not into a blood vessel.
Injection of steroid – The steroid, often mixed with local anaesthetic, is slowly injected. You may feel some pressure or a sense of fullness.
Recovery period – You will be moved to a recovery area where nurses monitor you for around 15–30 minutes. Once you are steady on your feet and feel well, you can go home.

You should arrange in advance for someone to take you home, as you should not drive yourself after the procedure.

5. Does It Hurt?

Most people are surprised by how manageable the procedure feels. It is common to feel some pressure or discomfort, but not usually sharp pain.

You may notice:

A brief sting or burn when the local anaesthetic is injected into the skin.
A feeling of pressure, fullness, or warmth in the back or down the leg or arm as the medicine is injected.
Occasionally, a short-lived electric or shooting sensation if the needle is close to a nerve. If this happens, tell the doctor so they can adjust the needle position.

Most patients tolerate the procedure well, and it is usually over very quickly. If at any point the discomfort feels too much, you can let the team know and they will pause and adjust.

6. What to Expect Afterwards

Everyone responds slightly differently, but some common experiences after an epidural steroid injection include:

Temporary numbness or weakness – If local anaesthetic is used, your legs (or arms, for neck injections) may feel heavy, weak, or numb for a few hours. This is expected and usually wears off the same day.
Possible short-term increase in pain – Some people notice their pain is slightly worse for a day or two. This is sometimes called a steroid flare and usually settles on its own.
Onset of benefit – The steroid takes time to work. Many people notice improvement within 1–2 weeks, though some feel better sooner.
How long relief lasts – Pain relief can last from a few weeks to several months. In some people it lasts longer, in others it is shorter. Unfortunately, it is not possible to predict exactly how long it will help.

You should:

Arrange a lift home – Do not drive yourself on the day of the procedure.
Rest on the day – Take it easy, avoid heavy lifting or strenuous activity.
Return to gentle activity the next day – Short walks and light movement are usually encouraged. Follow any specific advice given by your pain team or physiotherapist.

If you develop severe headache, fever, new weakness, difficulty passing urine, or loss of bowel or bladder control, contact your hospital or emergency services immediately, as these symptoms need urgent assessment.

7. How Well Does It Work? (The Evidence)

Epidural steroid injections have been studied in many clinical trials. Overall, the evidence suggests they can provide short- to medium-term relief of nerve-related pain, especially sciatica.

A 2022 systematic review (PubMed ID: 35526969) found that ESIs for lumbar radiculopathy (sciatica from nerve root irritation in the lower back) can reduce pain and improve function in the short term compared with placebo or other treatments. Other systematic reviews and randomised controlled trials support this finding.

The evidence is stronger for radicular (nerve) pain than for axial (pure back) pain. In other words, ESIs are more likely to help when pain is running down a limb due to a pinched or inflamed nerve, rather than when it is limited to the back or neck alone.

Long-term results are more mixed. ESIs do not cure the underlying structural problem in the spine, and in many studies the difference between injection and comparison treatments becomes smaller over time. However, they can still be very useful in providing a window of reduced pain that allows you to stay active, continue working, and engage fully in rehabilitation.

For some patients, ESIs may help to delay or reduce the need for surgery, although this is not guaranteed. Responses vary widely: some people experience major relief, some moderate improvement, and some little change.

Professional guidelines, including those from the American Society of Interventional Pain Physicians (ASIPP) and NICE, recognise epidural steroid injections as part of a multimodal pain management plan when used appropriately. Educational and review resources such as StatPearls (NCBI Bookshelf, NCBI/NBK470189) and research articles (for example, PMC8744824) also support their use in selected patients with nerve-related spinal pain.

8. Risks and Side Effects

All medical procedures carry some risk. Serious problems after an epidural steroid injection are uncommon, but it is important to be aware of both common and rare side effects.

Common (usually mild and short-lived)

Temporary increase in pain (steroid flare) for 1–2 days
Facial flushing (warm, red face) for a day or so
Temporary rise in blood sugar, especially in people with diabetes
Headache
Difficulty sleeping (insomnia) for a night or two

Less common but important

Dural puncture (“wet tap”) – the needle may accidentally enter the sac of fluid around the spinal cord. This can cause a particular type of headache that is often worse when sitting or standing. It usually improves with rest and fluids, but sometimes needs further treatment.
Infection – infection at the injection site or deeper in the spine (epidural infection) is rare, estimated at less than 1 in 1,000 procedures, but can be serious.
Bleeding / haematoma – bleeding into the epidural space is rare but can compress nerves.
Nerve damage – very rare, but possible if a nerve is directly injured or compressed by bleeding or infection.
Epidural abscess – a collection of pus around the spinal cord or nerves; this is very rare but serious and usually requires urgent treatment.

With repeated injections over time

Because the steroid medicine is absorbed into the body, having many injections over a long period may increase the risk of:

Bone thinning (osteoporosis)
Adrenal suppression (the body’s own steroid production being reduced)

For these reasons, most specialists recommend no more than about 3–4 injections per year per spinal region, and only when there is clear benefit.

Serious but very rare risks

Spinal cord injury is extremely rare, but has been reported, particularly with certain types of steroid (called particulate steroids) and with some transforaminal injections performed without careful precautions. Using imaging guidance, choosing appropriate medicines, and following safety guidelines greatly reduces this risk. Your pain doctor can explain how they minimise these risks in their practice.

9. Who Should Not Have One?

Your team will check your medical history to ensure an epidural steroid injection is safe for you. In general, ESIs may not be suitable if you have:

Active infection anywhere in the body
Blood-thinning medications (such as warfarin, some newer anticoagulants, or strong antiplatelet drugs) that have not been safely paused or adjusted – never stop these medicines without clear medical advice
Known allergy to steroids, local anaesthetic, or contrast dye used for imaging
Uncontrolled diabetes – the injection can raise blood sugar; careful monitoring and planning are needed
Pregnancy – risks and benefits need to be considered very carefully
Previous serious reaction to an epidural steroid injection

Always give your pain team a full list of your medicines and medical conditions so they can advise you safely.

10. Questions to Ask Your Pain Team

Good communication helps you feel more in control. You might find it useful to ask:

Which type of epidural steroid injection are you recommending for me (interlaminar, transforaminal, or caudal), and why?
Will you use X-ray or ultrasound guidance during the injection?
What steroid medicine will you use, and is it particulate or non-particulate?
Roughly how many injections might I need, and how will we decide whether to repeat it?
What benefits should I realistically hope for, and over what timeframe?
What side effects or warning signs should make me call the clinic, my GP, or attend emergency care?
What should I do if my pain becomes much worse in the days after the injection?
How does this injection fit into my overall treatment plan, including physiotherapy and self-management?

11. Key Points

Epidural steroid injections are a well-established, evidence-backed option for certain types of nerve-related spinal pain, especially sciatica and other forms of radiculopathy. They are most effective when used as part of a broader pain management plan that includes physiotherapy, exercise, and active self-care.

ESIs are not a permanent fix and they do not reverse underlying wear and tear in the spine, but they can provide a valuable period of reduced pain. This window of relief may help you move more freely, improve your sleep, and focus on rehabilitation, which together can make a meaningful difference to your quality of life.

If you are unsure whether an epidural steroid injection is right for you, discuss your questions and concerns openly with your pain team so you can decide together.

Disclaimer: The information in this article is intended for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always speak with a qualified healthcare professional before making decisions about your care.