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Epidural steroid injections for back pain

What is an epidural steroid injection?

An epidural steroid injection is the delivery of strong anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space.

What happens during the procedure?

Epidural steroid injection (ESI) is done in a hospital or outpatient clinic. The procedure is done in the following way:

  • You will change into a gown.
  • You will then lie flat on an x-ray table with a pillow under your stomach. If this position causes pain, you can either sit up or lie on your side in a curled position.
  • The health care provider uses a special solution to clean the area of your back where the needle will go. Most of the time this shot is given in your lower back in the area where your pain comes from. Medicine may be used to numb the area. You may be given medicine to help you relax.
  • The doctor inserts a needle into your back. The doctor may use an x-ray machine that produces real-time images to help guide the needle to the correct spot in your lower back.
  • A mixture of steroid and numbing medicines is used. The steroid decreases swelling and pressure on the larger nerves around your spine.
  • You may feel some pressure during the injection, but most of the time the procedure is not painful. It is important not to move during the procedure because the injection needs to be very precise.
  • You will be watched for 15 to 20 minutes after the injection before going home.

Why the procedure is performed

Your doctor may recommend ESI if you have pain that spreads from the lower spine to the hips or down the leg. This pain is caused by pressure on a nerve as it leaves the spine, most often due to a bulging disk.

ESI is used only when your pain has not improved with medicines, physical therapy, or other nonsurgical treatments.

After the procedure

You may have some pain at the site where the needle was inserted. This should last only a few hours.

You may be told to rest for the remainder of the day.

Your pain may become worse for 2 to 3 days after the injection before it begins to improve. The steroid usually takes 2 to 3 days to work.

If you receive medicines to make you sleepy, have someone drive you home from the hospital or clinic.

How well do epidural steroid injections work?

ESI provides short-term pain relief in at least half of the people who receive it. Symptoms may remain better for weeks to months, but rarely up to a year.

The procedure does not cure the cause of your back pain. However, it can make it feel better. You will need to continue back exercises and other treatments.

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Review Date: 4/3/2018

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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