Epidural Steroid Injection FAQ

What is an epidural steroid injection?

An injection of a local anesthetic plus a potent anti-inflammatory (a corticosteroid, related to cortisone but much stronger) into the epidural space — the area between the layers of tissue surrounding the spinal cord and the nerves branching from it.

What is its purpose?

To deliver a large dose of powerful anti-inflammatory medication right to an inflamed, irritated nerve — reducing the swelling that causes pain, tingling, numbness, and related symptoms.

How long does it take?

The injection itself takes only a few minutes, but plan on 45 minutes to about 90 minutes total: the doctor reviews your history and examines you beforehand to confirm the epidural is appropriate, then you're monitored for 20–30 minutes afterward before going home.

What's actually injected — is it two shots?

One injection. A local anesthetic (such as lidocaine or bupivacaine) and a corticosteroid (betamethasone, triamcinolone, or methylprednisolone) are mixed and given together.

Are these the steroids bodybuilders use?

No. These are anti-inflammatory corticosteroids, not the anabolic steroids weightlifters take.

Will it hurt?

You'll feel the initial lidocaine injection that numbs the skin and deeper tissue. After that, most people feel strong pressure rather than pain. If you've had prior back surgery or a difficult epidural before, tell your doctor — several techniques can make it easier.

Will I be "put out"?

No. It's done under local anesthesia. Most people are surprised at how manageable it is.

How is it performed?

You'll sit up, lie on your side, or lie on your stomach. EKG, blood pressure, and oxygen monitors are placed, your back is cleaned with antiseptic, and the injection is done using sterile technique. Afterward you'll lie on your back or on your side with the painful side down.

What should I expect afterward?

Right after, your legs may feel slightly heavy or numb and your pain may drop noticeably — that's the local anesthetic, and it lasts only a few hours. Your pain will then return, and you may have a "sore back" for a day or two from the needle and initial steroid irritation. The real, lasting relief typically begins 48 to 72 hours later.

What should I do after?

Have someone drive you home and take it easy the rest of the day — don't start new activities or do anything out of the ordinary.

Can I work the next day?

Most people can, depending on the type of work and their pain and activity level beforehand.

How long does the effect last?

The immediate numbness is the anesthetic and wears off in hours. The steroid begins working in about 3 to 5 days and can remain active in the epidural space for up to two weeks.

How many injections will I need?

If the first doesn't relieve your symptoms within a week or two, a second may be recommended, and similarly a third. Studies generally show that a series (up to three) provides the best long-term results — but we base this on your response, not a reflexive schedule.

Can I have more than three?

If three in a row haven't given lasting relief, a fourth likely won't either. But if a series worked well and your pain later returned or you reinjured yourself, a new series can begin after about four months. The spacing matters because too much corticosteroid can temporarily suppress your body's own steroid production.

Doesn't cortisone weaken joints if injected too often?

That concern applies to steroids injected into joints — an epidural is different, placing medication in the epidural space rather than a joint.

Will it help me?

It's genuinely hard to predict. As a rule, people with leg pain (sciatica) respond better than those with back pain alone, and people whose pain has lasted less than six months tend to respond better than those with long-standing pain — one more reason not to wait.

I had one before and it barely worked. Why?

Several possibilities: it may not have reached the inflamed area for anatomical reasons, a single injection often gives only short relief when a series was needed, the technique may have been imperfect, or the pain may be coming from a different source than assumed.

Will it cure my disc?

No. A bulging or herniated disc remains after the pain resolves — which is exactly why you'll follow up afterward to learn techniques that reduce the chance of recurrence. The injection buys you a window; what you do in it determines how long relief lasts.

What are the risks and side effects?

Two categories. The needle can cause pain, spinal puncture with headache, infection, bleeding in the epidural space with possible nerve injury, or a temporary worsening of symptoms. The medications can cause allergic reactions, temporary leg numbness, water retention, blood sugar elevation (mainly in diabetics), and short-term suppression of natural cortisone production.

Who should not have this?

Anyone allergic to the medications, on blood thinners such as warfarin (Coumadin), or with an active infection.

Why is it done in a surgery center rather than an office?

Good medical practice — and California law. Because local anesthetic is injected into the epidural space, an epidural is considered a major regional anesthetic that must be performed in an accredited facility with full monitoring and emergency equipment, not a doctor's office. Ours are performed at the accredited Newport Center for Special Surgery.