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Epidural Steroid Injection: Effective Pain Management Technique

Epidural steroid injections (ESIs) are a widely utilized pain management treatment for individuals experiencing chronic pain in the neck, lower back, and other areas related to spinal nerves. The procedure involves injecting a combination of anti-inflammatory medicine, typically a steroid or corticosteroid, and an anesthetic into the epidural space surrounding the spinal nerves. This space is a fat-filled area designed to protect the spinal cord and neighboring nerves from potential damage. By reducing inflammation and fluid buildup in the spine, ESIs can help alleviate discomfort and improve overall quality of life for patients.

The primary purpose of an ESI is to deliver pain relief in a fast and efficient manner. However, it is essential to note that the effects of the injection can vary from person to person. In some cases, pain relief is short-term, while others may experience more extended periods of respite. The injections can also be utilized as a diagnostic tool, pinpointing the precise location of an individual's pain and guiding further treatment or interventions.

As a non-surgical treatment method, ESIs have become a popular choice for those seeking relief from spinal nerve pain. While the injections have proven to be beneficial for many, it is crucial to weigh the possible benefits against the potential risks or side effects. Consulting with a healthcare professional is essential to determine if an epidural steroid injection is an appropriate option for the individual's symptoms and condition.

Indications for Epidural Steroid Injections

Epidural Steroid Injections (ESIs) are commonly used for pain relief in cases of chronic back, neck, and leg pain. These injections can be effective in reducing inflammation and providing relief for various conditions related to the spine and nerves. The primary indications for ESIs include:

  • Herniated or bulging disc: ESIs may alleviate pain caused by a herniated or bulging disc that pinches nerves, leading to pain.
  • Spinal stenosis: The injections can help manage pain resulting from spinal stenosis, which is the narrowing of one or more spaces within the spine.
  • Lumbar radicular pain: Also known as sciatica, lumbar radicular pain is caused by spinal nerve root inflammation and irritation in the lower back region.
  • Degenerative disc disease: ESIs can help manage pain resulting from the wear-and-tear of spinal discs over time.
  • Radiculopathy: Epidural steroid injections have been used in the treatment of radicular pain, which is a neuropathic pain syndrome along the sensory distribution of one or more spinal nerves.
  • Arthritis: ESIs can be effective in providing relief from pain caused by inflammation of the joints in and around the spine.

It is important to note that ESIs are considered medically reasonable and necessary when specific requirements are met, such as having a history, physical examination, and concordant radiological image-based diagnostic testing supporting one of the mentioned indications according to the LCD. This ensures the safety and efficacy of the treatment for each individual patient.

Types of Epidural Steroid Injections

Epidural steroid injections (ESIs) are used to treat pain originating in the spine and can be classified by the location along the spine and the path of the needle to reach the epidural space. In this section, we will discuss three types of epidural steroid injections: Interlaminar, Transforaminal, and Caudal.


Interlaminar injections are the most common type of ESIs. They are administered between the lamina, which are the bony plates that form the "roof" of the spinal canal. The needle is positioned in the epidural space and the steroid medication is delivered to reduce inflammation and provide pain relief. Interlaminar injections can be performed in the cervical, thoracic, or lumbar regions of the spine.

There are a few advantages to interlaminar injections:

  • Widely used and well-established technique
  • Provides pain relief for a broader area since medication is distributed across multiple spinal nerve levels

However, there are also some disadvantages:

  • Possibility of dural puncture, leading to headache
  • May not be as precise for targeting specific nerve roots


Transforaminal ESIs involve inserting the needle between the spinal cord and the spinal vertebrae, near the area where the spinal nerve exits the spine. This approach allows for the delivery of the steroid medication directly to the inflamed nerve root, providing more focused pain relief. Transforaminal injections are primarily utilized in the lumbar region of the spine but can be done in the cervical and thoracic areas as well.

The advantages of transforaminal injections include:

However, this approach also has some disadvantages:

  • Risk of nerve or spinal cord injury if the needle is incorrectly placed
  • May be less effective for treating pain that is spread over a large area


Caudal epidural injections are administered through the sacral hiatus, an opening in the sacrum, which is a triangular bone located at the base of the spine. This approach is most commonly used to treat pain in the lower lumbar region and the legs. Caudal injections are less commonly utilized compared to interlaminar and transforaminal injections but can be an option for certain patients.

Advantages of caudal injections are:

  • Can provide relief for multiple spinal nerve levels at once
  • Lower risk of complications compared to other approaches

Disadvantages include:

  • Less precise targeting of specific nerve roots
  • May not be as effective for some patients

In summary, there are three main types of epidural steroid injections: Interlaminar, Transforaminal, and Caudal. Each approach has its advantages and disadvantages, and the best option for an individual will depend on their specific condition and needs.


An epidural steroid injection is a minimally invasive procedure that aims to relieve pain caused by inflamed spinal nerves. The process involves injecting a steroid or corticosteroid into the epidural space, which is an area close to the spinal cord filled with fat cells and blood vessels. This injection can help alleviate neck, arm, back, and leg pain stemming from certain conditions or injuries1.

Before the procedure begins, patients are typically asked to change into a medical gown and lie face down on a comfortable table with a pillow under their abdomen. In some cases, healthcare providers may administer a sedative to help patients relax2.

The skin around the injection site is first cleaned and numbed using a local anesthetic. A needle is then inserted through the skin and guided towards the epidural space3. This process is done with the assistance of fluoroscopy, an X-ray imaging technique that displays moving images on a screen, helping to ensure that the needle is accurately positioned4.

Once the needle reaches the desired location, a small amount of contrast dye is injected to confirm the correct placement. The healthcare provider then slowly administers the steroid medication into the epidural space5. The entire procedure typically takes around 15-45 minutes to complete6.

Patients can usually return home the same day and resume normal activities within a day or two. It is important to note that pain relief from an epidural steroid injection can vary, lasting anywhere from several days to even years7.

Medications Used

Epidural steroid injections involve the administration of a combination of local anesthetic and steroid medication into the epidural space. The primary goal of these injections is to provide relief from inflammation and pain in the spine. There are several types of steroid medications that can be used in epidural injections, each with its own unique properties.

The most commonly used corticosteroids in epidural steroid injections include:

  • Methylprednisolone acetate
  • Triamcinolone acetate
  • Betamethasone acetate and phosphate
  • Dexamethasone phosphate

These steroid medications work as anti-inflammatory agents, reducing swelling and inflammation in the affected area, and ultimately providing relief from pain. The choice of steroid medication depends on the specific condition being treated, the location of the injection, and the preferences of the medical professional administering the injection.

Local anesthetics are also used in conjunction with steroid medications to numb the area and provide immediate pain relief. Some of the common local anesthetics used in epidural steroid injections include:

  • Lidocaine
  • Bupivacaine
  • Ropivacaine

These anesthetics may be administered in varying doses and durations to achieve the desired level of pain relief and numbness.

It is important to note that while epidural steroid injections can provide significant relief from pain and inflammation, they are not a cure for underlying spinal conditions. Furthermore, the duration and effectiveness of the relief provided by these injections can vary from patient to patient. Regular follow-up with a medical professional is essential to ensure optimal management of the condition and determination of the most appropriate course of treatment.

Risks and Complications

Epidural steroid injections can provide significant relief from pain and inflammation in the spine; however, they do come with certain risks and complications. In this section, we will discuss some of the potential side effects and complications associated with this procedure.

Side Effects

Some possible side effects of epidural corticosteroid injections include:

  • Steroid flush, characterized by flushing of the face and chest, with warmth and an increase in temperature lasting for several days.
  • Sleeping problems
  • Anxiety
  • Menstrual changes
  • Water retention

These side effects are usually temporary and subside as the corticosteroid medication wears off.


Though rare, complications may arise from epidural steroid injections:

  • Bleeding: If any blood vessels are affected during the procedure, it may lead to bleeding. Patients with a bleeding disorder or on blood-thinning medication are at higher risk.
  • Infection: Although unlikely, there's a risk of developing an infection at the injection site or even an epidural abscess.
  • Dural puncture: If the dura mater, a membrane surrounding the spinal cord, is unintentionally punctured, it can lead to a severe headache that worsens when sitting up or standing.
  • Nerve damage: Nerve injury can occur if the needle accidentally punctures a nerve or if the injected medication causes nerve irritation.
  • Allergic reaction: Some patients may have an adverse reaction to the medications used in the injection

Additionally, there's a possibility of aggravating a herniated disc if the needle contacts the disc material. While the probability of this occurring is low, it's essential to be aware of potential complications.

It's important to consult with a qualified medical professional to discuss the benefits, risks, and potential complications associated with epidural steroid injections, taking into account the patient's specific medical history and conditions.

Aftercare and Recovery

After receiving an epidural steroid injection, it is crucial to give your body adequate time to rest and recover. It is generally recommended to rest and take things easy for 24 hours following the injection. This does not mean complete inactivity, but rather being cautious and avoiding any strenuous activities that may strain the back.

Pain is a common symptom after the procedure; it may even become worse for two or three days before beginning to improve. Epidural steroid injections typically start working within two to seven days, with pain relief potentially lasting from several days to a few months or longer, depending on individual circumstances.

During the initial recovery period, it is essential to focus on pain management. Over-the-counter pain medications can be used as needed, under the guidance of your healthcare provider. Keep in mind, the corticosteroids may take 3-7 days to reach optimal effect.

As you progress in your recovery, you may start incorporating gentle exercises and physical therapy, designed to strengthen the muscles around the injection site and improve overall function. It is imperative to work closely with a physical therapist to ensure you are performing the exercises safely and to avoid potential complications.

For long-term chronic pain management, follow-up appointments with your healthcare provider are necessary to evaluate the effectiveness of the epidural steroid injection and discuss any additional treatment options that may be beneficial. The recovery process may involve multiple injections, rehabilitation, and a combination of therapies to achieve the desired level of pain relief and functionality.

In summary, proper aftercare and recovery protocols following an epidural steroid injection include appropriate rest, pain management, exercise, physical therapy, and follow-up appointments for optimal results while avoiding exaggerated or false claims. Always consult with your healthcare provider for personalized recommendations and guidance throughout the recovery process.

Role of Healthcare Providers

Epidural steroid injections (ESIs) are a common treatment for managing chronic pain due to spinal nerve root inflammation. The procedure involves injecting corticosteroids around the spinal nerves to reduce inflammation and provide pain relief. Healthcare providers play a vital role in ensuring the safety and effectiveness of this procedure.

An anesthesiologist specializes in providing pain relief and anesthesia during medical procedures. In the case of epidural steroid injections, they may be responsible for administering local anesthesia to numb the injection site and make the procedure more comfortable for the patient. Additionally, they closely monitor the patient's vital signs and address any complications or adverse effects that may arise during the procedure.

A radiologist uses medical imaging technology such as X-ray machines to guide the needle during the ESI procedure. By providing real-time moving images on a screen, they help ensure that the needle is placed in the correct location, reducing the risk of complications and improving the overall efficacy of the treatment 1.

Physiatrists are medical doctors who specialize in physical medicine and rehabilitation. They often work closely with pain medicine specialists to create a comprehensive treatment plan for patients with chronic pain. Physiatrists may use ESIs in conjunction with other pain management strategies, such as physical therapy or medication, to provide the most effective treatment for their patients.

Healthcare providers, including anesthesiologists, radiologists, and physiatrists, collaborate to ensure the safe and effective administration of epidural steroid injections. They all take part in various stages of the procedure, from assessing patient eligibility to providing post-injection care, and can help patients manage their chronic pain, improve their quality of life, and potentially avoid more invasive interventions such as surgery.

Extensive communication among healthcare providers is essential for successful ESIs 2. For instance, pain medicine specialists may consult with radiologists about the preferred approach for a specific patient, while the anesthesiologist may collaborate with other providers to ensure the patient remains comfortable throughout the procedure.

In conclusion, the role of various healthcare providers, from anesthesiologist to physiatrist, is crucial to the successful administration of ESIs. Through their expertise and collaboration, they offer safe and effective pain management to patients struggling with chronic pain due to spinal nerve root inflammation.

1 Johns Hopkins Medicine: Epidural Corticosteroid Injections
2 Cleveland Clinic: Epidural Steroid Injection (ESI)

Additional Information

Epidural steroid injection (ESI) is a non-surgical procedure used to provide relief from chronic pain associated with various spinal conditions. It involves administering anti-inflammatory medicine, typically a steroid or corticosteroid, into the epidural space surrounding the spinal nerves to alleviate pain caused by irritation and inflammation of spinal nerve roots1.

Conditions Treated with Epidural Steroid Injections

Several spinal conditions can benefit from ESI as a therapeutic intervention. Some of these include:

  • Spondylolysis
  • Scoliosis
  • Spondylolisthesis
  • Disc herniation
  • Lower back pain

Epidural steroid injections particularly target lumbar epidural steroid injections for patients experiencing lower back pain2.

Potential Side Effects

As with any medical procedure, some side effects may occur. While most of these are temporary, it is essential to consider the potential risks associated with ESI:

  • Insomnia
  • Nausea
  • Fainting
  • Low blood pressure
  • Flushing

Improvements in Quality of Life

Administering ESI can improve patients' quality of life by reducing pain and other debilitating symptoms caused by spinal disorders. This therapeutic approach, when used in conjunction with appropriate diagnostic measures, can provide lasting pain relief and make everyday activities, such as walking and other movements, more comfortable3.


  1. Cedars-Sinai 2

  2. Cleveland Clinic 2

  3. Johns Hopkins Medicine 2

  4. Spine-health

  5. Cleveland Clinic

  6. Cedars-Sinai

  7. Cleveland Clinic