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How does an epidural injection treat back pain? Our physicians explain
An epidural steroid injection places a small amount of anti-inflammatory steroid next to a spinal nerve that is irritated, most often by a herniated disc pressing on it. Calming that inflammation can ease back pain and pain that shoots down the leg (sciatica). Relief often builds over several days, and for many patients our physicians see it last around three months, sometimes longer. The injection does not push the disc back into place. Its job is to lower pain enough that you can do physical therapy, which treats the underlying problem.
Epidural injection videos are some of the most-watched clips on our YouTube channel. Together, the four below have been viewed more than 12 million times. Many viewers are where these patients were: in pain, and nervous about a needle near the spine. Here is what the procedure is for, what it feels like, and what it can and cannot do.
What an epidural injection does
In the clip on the right, the physician describes a typical case. The patient "has a lot of pain in his lower back going down his leg." The reason is "a disc herniation pushing against his nerve." The physician injects "a little bit of steroid" to "decrease the inflammation in that area," so the patient "has less pain and he's able to tolerate physical therapy."
That is the core idea. When a disc bulges or herniates, it can press on a nerve root and inflame it, causing back pain, leg pain, numbness or tingling. The steroid is an anti-inflammatory medication placed in the epidural space next to the irritated nerve. Epidurals are also used for leg pain from spinal stenosis and for arm pain from a disc or nerve problem in the neck.
What the procedure is like
At Precision Care, a pain physician uses live X-ray (fluoroscopy) to guide the needle to the right level of the spine. The skin is numbed first. Most patients feel pressure and a brief pinch. The visit, including time to rest afterward, takes about an hour, and most people can return to light activity the next day.
In the first video, a patient treated by Dr. Ashley Marcus and the team says she "was very, very nervous" beforehand and felt "very good" afterward. Feeling anxious before a spinal injection is common. Tell your physician, and ask them to explain each step as they go.
How long does an epidural injection last?
Our physician answers this directly in the video on the left: "the usual amount of time that a steroid helps the patient with their pain is roughly about three months." The video's notes add that the steroid usually starts to work within about 2 to 7 days, and relief sometimes lasts longer. Some people get less relief, or none. If the first injection helps, your physician may discuss whether repeating it makes sense. Steroid injections are limited in how often they can be given.
Will an epidural heal a herniated disc?
No, and our physician is clear about it in the video on the right: the purpose "is to decrease inflammation that's caused by the disc herniation, but the disc herniation won't actually go back in." Think of the injection as a window of lower pain. During that window, physical therapy can build core and hip strength, improve how you move, and lower the chance of another flare.
Who is a candidate?
An epidural is usually considered for pain from an irritated spinal nerve that has not settled with time, activity changes, medication and physical therapy. A physician confirms the cause with an exam and, when needed, imaging. Epidurals are not right for everyone. Tell your physician if you take blood thinners, have diabetes, have an infection, or could be pregnant.
Go to an emergency room right away if back pain comes with new weakness in the legs, numbness in the groin or inner thighs, or loss of bladder or bowel control. These can be signs of serious nerve compression.
Related care at Precision Care
Where to get care in New York City
Epidural steroid injections at Precision Care are performed by our pain physicians with X-ray (fluoroscopy) guidance, and therapy follows in the same practice. You can request an appointment online or call the office closest to you. An online request is not a confirmed booking until the office contacts you.
150 E 55th St, Suite 401, New York, NY 10022
(212) 840-0135
Questions patients ask
What is an epidural steroid injection for back pain?
It is an injection of anti-inflammatory steroid into the epidural space next to an irritated spinal nerve, guided by X-ray. It is most often used for back and leg pain (sciatica) caused by a herniated disc or spinal stenosis.
How long does an epidural injection last?
Our physicians explain that relief usually lasts roughly three months, and sometimes longer. The steroid often starts working within about 2 to 7 days. Results vary, and some people get little or no relief.
Does an epidural steroid injection heal a herniated disc?
No. It reduces the inflammation the disc herniation causes, but the herniation does not go back in. The lower pain makes it easier to do physical therapy, which addresses the underlying problem.
Is an epidural injection painful?
The skin is numbed first, and most patients feel pressure and a brief pinch. Many patients are nervous beforehand. Telling your physician helps, and they can explain each step as they go.
What should I do after an epidural injection?
Most people rest the day of the injection and return to light activity the next day, then continue or start physical therapy as planned. Follow your physician's specific instructions and call the office if you notice anything unusual.
Educational only, not medical advice. These videos and this article explain common treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.
More videos and articles on the Precision Care blog