Epidural Steroid Injections

Epidural Steroid Injections

An epidural steroid injection (ESI) is minimally-invasive procedure used to alleviate chronic neck and back pain as well as a variety of other conditions that are caused by inflamed spinal nerves. It involves the injection of a local anesthetic (numbing medicine) and steroid (a potent anti-inflammatory medication) into the epidural space of the spine.

The epidural space is a fat-filled “sleeve” that surrounds the membrane covering of the spinal cord and nerve roots. Nerves travel through the epidural space to the back and into the legs (or to the neck and into the arms). Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structures of the spine. An epidural steroid injection provides pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine.

Who is a candidate?

 Patients with pain in the lower back, leg, neck or arm may benefit from epidural steroid injections. ESIs can be helpful for treating the following conditions:

  • Herniated or bulging discs—which irritate adjacent nerves and cause pain.
  • Post-herpetic neuralgia—pain after shingles.
  • Post-laminectomy syndrome (failed back surgery syndrome)—chronic pain after back surgery.
  • Radiculopathy— pain that progresses down the
  • Sciatica (radiculitis)—pain or sensory changes along the sciatic nerve pathways in the arms/hands or legs/feet.
  • Spinal stenosis—narrowing of the spinal canal or nerve root exits
  • Spondylolisthesis—slippage of the vertebral column.
  • Tumor-related inflammation.

While epidural steroid injections do not correct any of the above medical problems, they can improve the level of pain and break the cycle of inflammation, allowing the body to compensate for the condition. The injections alone may be enough to provide sufficient relief, or they may be used in conjunction with other therapies to ensure a more productive recovery.

It is important to understand that ESI is not right for everyone. Injections should NOT be performed on individuals with an infection, bleeding problems, high blood pressure or glaucoma, or on individuals who are pregnant. If you think you have any of these conditions, please discuss this during your initial medical consultation.

How is this injection done?

The injections are performed under local anesthesia. (Patients who are particularly nervous may also have intravenous sedation, to help them relax.) The procedure usually takes no more than 15 to 20 minutes, followed by a brief recovery period.

Before receiving the injection, your back and/or neck will be cleansed with alcohol, and then a local anesthetic will be administered to numb the treatment area. Using a fluoroscope (a special x-ray), a hollow needle will be directed through your skin and between the bony vertebrae into the epidural space. You may feel some discomfort, but typically it’s more pressure than pain. Once in the epidural space, x-ray dye will be injected to confirm the correct location of the needle. The steroid mixture will then be injected, completing the procedure.

After the injection, your skin will be washed and a band aid applied. You will be moved to the recovery area where you will be monitored for an appropriate time (usually 20-40 minutes). After you are given discharge instructions and your doctor authorizes the discharge, you will be sent home.


Depending on the amount of inflammation, many patients experience sufficient pain relief after just one or two injections. Other people may need three or four injections. The exact number needed depends your individual response to each treatment. If your pain significantly improves after the first injection, you may not need any more. However, if you are still in considerable pain, a second (or third) injection probably should be done. When multiple injections are necessary, these are done 2 to 3 weeks apart.

For most patients, the steroid usually begins to take effect within 3 to 5 days. In some cases, though, it can take up to a week to feel the benefits. Results are long-lasting; the injection or series of injections you receive can provide pain relief for up to one year. Most often injections are performed in conjunction with a physical therapy program to allow the patient to strengthen the back muscles and prevent future pain episodes.

For more information about the epidural steroid injection or to schedule a consultation at Advanced Pain Consultants, please call (919) 510-7901.

A Holistic Approach to Pain Management