Epidural steroid injections are a way of using an anti-inflammatory medication (steroid) and a numbing agent to treat pain inside the spinal canal but just outside the covering of the spinal cord (epidural space).

Nerves travel through the epidural space and into the legs and arms. Irritation from a damaged disc or contact with the bony structures of the spine can cause these nerve roots to become inflamed.

At University of Maryland Pain Medicine, our specialists use this procedure to treat pain associated with a number of spinal conditions in both the neck and lower back. These include:

  • Degenerative disc disease
  • Herniated or bulging discs
  • Post-surgery back syndrome
  • Radiculopathy – pain radiating down arms or legs
  • Sciatica
  • Stenosis – narrowing in the spine

What Epidural Steroid Injections Do (and Don't Do)

An epidural steroid injection provides pain relief by reducing the swelling of the nerves as they exit the spine. It does not correct the pre-existing problem (such as herniated or bulging disc, arthritis, etc.) that caused the nerve inflammation.

Epidural steroid injections can prevent unnecessary surgery or delay the need for surgery when physical therapy or medications are not working well enough to manage the pain.

Often patients need more than one injection to receive long-term benefit. In fact, injections are usually in a series of three — each about three to four weeks apart. If the pain significantly improves, patients won't need more injections unless the pain begins to return.

Patient Information: Epidural Steroid Injections

How do I prepare for the procedure?

Your healthcare professional will provide you with full instructions for how to prepare. This information will include when you can eat prior to the procedure and what medications you can and cannot take.

If you are diabetic, pregnant or taking blood thinners, such as Coumadin (warfarin) or Plavix, let your doctor know.

You should arrange to have someone drive you home from the procedure.

What happens during the actual procedure?

The procedure typically takes about 10–20 minutes. You will lie on your stomach in an X-ray room. A technician will thoroughly clean the injection site with an antiseptic. You will receive an injection of numbing medicine with a very small needle. This may cause a burning or stinging sensation that usually lasts about 10 seconds.

Using X-ray guidance, the doctor will advance a needle into the epidural space, inject the steroid and numbing medicine, and remove the needle. A small adhesive bandage will cover the injections site.

What will I feel during the procedure?

Our team will make every effort to make you comfortable. Most people say the stinging of the numbing medicine is the most uncomfortable part. You may also feel pressure during the injection.

Many patients may feel a warm sensation in the back or down the legs with injection. This can be a sign the medication is working on the nerves.

What will happen after the procedure?

You will remain in our recovery area for about 20–30 minutes while we monitor your vital signs. Our pain management team will give you verbal and written discharge instructions. You may go home with your driver after your doctor authorizes discharge.

How will I feel after the injection?

Your pain may improve immediately, but temporarily, because of the numbing medicine. This will wear off after several hours. The steroid takes three to five days to have an effect in most people. Therefore, expect it to take several days before you feel the benefit of the injection.

You may have some soreness at the injection site, and your pain could worsen for a day or two after the procedure. Using an ice pack three or four times a day can help with this discomfort. You may take your usual pain medication after the injection.

What are the risks of the epidural steroid injections?

As with most procedures, there is a risk of bleeding, infection or allergic reaction to the medications used. Some mild short-term side effects include headache, nausea or dizziness. Rare brain or nervous system complications can occur.

Depending on the location of the injection, you may feel some temporary numbness or weakness in your legs or arms caused by the numbing medicine. If this interferes with your ability to walk safely, you will have to remain in our office until this resolves.

You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have a short-term elevation of blood sugars because of the steroid medication.