Healthcare providers use epidural steroid injections (ESIs) as a therapy option for certain causes of chronic pain. They inject an anti-inflammatory medication into the epidural space around your spinal nerves somewhere along your spine depending on what’s causing your pain. Approximately 50% of people experience temporary pain relief from ESIs.
An epidural steroid injection (ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the space around your spinal nerves known as the epidural space to treat pain caused by irritation and inflammation of spinal nerve roots. Healthcare providers use ESI injections as a chronic pain management tool. It can help relieve neck, arm, back and leg pain caused by inflamed spinal nerves due to certain conditions or injuries. Pain relief from an ESI may last for several days or months.
Other common names for an epidural steroid injection include:
Epidural steroid injections are not the same as epidural anesthesia or analgesia given for labor and childbirth or certain types of surgery. Those types of epidurals involve an injection of local anesthetic medication into the epidural space, which numbs certain regions of your body.
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An epidural steroid injection (ESI) is used for chronic pain management. Your provider injects a steroid or corticosteroid medication into the epidural space around your spinal cord.
Your spinal cord is a very important bundle of nerves that runs from your brain to your lower back. Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can send signals and communicate with the rest of your body.
The epidural space surrounds your spinal cord like a sleeve and contains fat, the dural sac, spinal nerves, blood vessels and connective tissue. Your spine (backbone) is composed of a column of many small bones called vertebrae. These bones help protect your spinal cord from injury. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.
Sometimes, nerve roots that are attached to your spinal cord can become pinched or inflamed. This can happen, for example, if you have a herniated disk. The inflamed nerves can cause pain, and the pain may radiate down your arm, buttocks and/or legs depending on where the inflamed nerve is along your spine.
With an epidural steroid injection, the steroid coats the irritated nerve(s) that are causing your pain and works to reduce swelling and pressure on the nerves. The steroid allows the nerve(s) time to heal. Epidural steroid injections most often lead to temporary pain relief, but in some cases, people experience long-term or permanent pain relief. ESIs can also sometimes identify the painful nerve.
Healthcare providers use epidural steroid injections to manage chronic pain caused by spinal nerve root inflammation. Many conditions can irritate your spinal nerve roots. This kind of nerve irritation most commonly presents as low back (lumbar) pain that radiates down your buttocks or legs. It also commonly presents as neck (cervical) pain that radiates to your arms.
Epidural steroid injections may help alleviate pain caused by the following conditions:
Epidural steroid injections are one of many treatments healthcare providers use to relieve certain causes of pain. Your provider may only recommend an ESI if your pain has not improved with physical therapy, medication or other nonsurgical therapies.
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Epidural steroid injections may be classified by their location along your spine — cervical, thoracic or lumbar — and by the path of the needle to get to the epidural space — interlaminar, transforaminal or caudal.
There are three types of ESIs based on which section of your spine your provider injects the medication, including:
There are a few different ways to reach the epidural space surrounding your spinal nerves. The following types of epidural steroid injections explain the path the needle takes to get to the epidural space:
Epidural steroid injections are a common form of therapy for certain causes of chronic pain. Healthcare providers perform approximately 9 million epidural steroid injections a year in the U.S.
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Epidural steroid injections are very technique-sensitive, so healthcare providers performing the injection must have significant specialized training. Healthcare providers who may perform ESIs include:
Before your ESI injection, it’s important to tell your healthcare provider if you are pregnant or might be pregnant. You also need to tell your provider which medications you are taking, including herbs, supplements and other non-prescription drugs.
Your healthcare provider will give you specific instructions about what you need to do to prepare for your ESI injection. Be sure to follow their instructions. Your provider may:
Questions that may be helpful to ask your healthcare provider before you get an epidural steroid injection include:
You will likely have your epidural steroid injection in a hospital or an outpatient clinic.
Depending on what’s causing your pain, your healthcare provider will inject the epidural somewhere along your spine. Here are the general steps of an epidural steroid injection procedure:
You’ll likely experience a minor pinch when your provider injects the local anesthetic to numb the area before your ESI injection.
You may not feel anything during the ESI injection, or you may feel the following:
If you have any discomfort during the injection, it usually disappears once the injection is finished.
If you feel intense, sharp pain during or after your ESI injection, tell your provider immediately.
After your injection, you may feel some discomfort where your healthcare provider inserted the needle. This is normal and should only last a few hours.
Your provider may tell you to take it easy and minimize your activity level for the rest of the day.
Your pain may become worse for two to three days after your ESI before it begins to improve. Epidural steroid injections start working within two to seven days, and the pain relief can last several days or longer.
Side effects of ESIs include:
The advantages of epidural steroid injections include:
Epidural steroid injections are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to ESI injections include:
While it’s very rare, complications from receiving an epidural steroid injection can have long-term consequences, including:
Since there are many causes of chronic pain an ESI can potentially help treat and each person is different, there are different levels of results for ESIs. However, approximately 50% of people who get an ESI experience pain relief.
While evidence shows that epidural steroid injections are effective in providing pain relief, the length of time the pain relief lasts may vary. This is especially dependent on the underlying cause of the pain. The pain relief may last for weeks to months, but rarely up to a year.
You may receive more than one ESI over time, but most healthcare providers limit people to two to three ESIs per year. In the majority of cases, ESIs do not cure the cause of your pain. People who have chronic pain and receive ESIs often need other forms of therapy for sustained pain relief.
If you experience any of the following symptoms after you’ve returned home from your ESI injection, be sure to contact your healthcare provider or go to the nearest hospital as soon as possible:
A note from Cleveland Clinic
When performed by a skilled healthcare provider, epidural steroid injections are an effective and generally safe therapy option for chronic pain caused by certain conditions. It’s important to remember that an ESI will most likely not cure your back or neck pain. Rather, it will provide temporary pain relief so that you can return to your normal activities. If you’re feeling anxious about receiving an ESI, don’t be afraid to ask your healthcare provider about it and the procedure. They can answer any questions you may have.
Last reviewed on 12/29/2021.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy