Epidural Steroid Injections: How They Work for Chronic Back and Neck Pain

If you’ve been dealing with chronic back or neck pain, chances are you’ve heard about epidural steroid injections (ESIs). Maybe your doctor has suggested them, or maybe you’ve read about them online while searching for relief. But what exactly are they? How do they work? Are they safe? In this post, we’ll break down everything you need to know about epidural steroid injections—what they are, how they work, and when they might be the right option for you.

What Is an Epidural Steroid Injection?

An epidural steroid injection is a minimally invasive procedure used to relieve pain in the spine. It involves injecting a combination of corticosteroid (a powerful anti-inflammatory medication) and a local anesthetic directly into the epidural space—the area around the spinal cord where nerve roots exit.

These injections are commonly used to treat:

• Chronic lower back pain
• Neck pain
• Sciatica (pain radiating down the leg)
• Cervical radiculopathy (pain radiating into the arms)
• Herniated discs
• Spinal stenosis
• Degenerative disc disease

The goal is to reduce inflammation and pain, improving function and potentially delaying or avoiding the need for surgery.

How Does It Work?

Let’s break it down step by step:

1. Understanding the Source of Pain

Chronic back and neck pain often result from inflammation around the spinal nerves. Conditions like a bulging disc or spinal stenosis can compress nerve roots, causing irritation, inflammation, and pain that radiates to other parts of the body.

2. Delivering Medication Directly to the Problem Area

Unlike oral medications that have to travel through your entire system, an ESI delivers potent anti-inflammatory medication right to the site of the inflammation. The steroid helps reduce swelling, pressure, and pain, while the anesthetic offers immediate but short-term relief.

3. Pain Relief Timeline

• Immediate relief (from the anesthetic) may occur within minutes or hours.
• Steroid effects usually kick in within 2–7 days.
• Relief can last anywhere from a few weeks to several months, depending on the individual and the severity of the condition.

Types of Epidural Steroid Injections

There are three main types of ESIs, depending on where the injection is placed:

1. Interlaminar ESI

• Injected between the laminae (bones of the spine)
• Targets a wider area
• Often used when pain is not confined to a specific nerve

2. Transforaminal ESI

• Injected near the nerve root as it exits the spinal column
• Provides targeted relief
• Commonly used for radiculopathy (nerve root pain)

3. Caudal ESI

• Injected into the sacral hiatus at the base of the spine
• Least invasive
• Used when multiple nerve roots are involved or when other routes are difficult

What to Expect During the Procedure

Most epidural steroid injections are done as outpatient procedures. Here’s a general overview of what happens:

1. Preparation: You may be asked to change into a gown and lie face down (for lumbar injections) or face up/sideways (for cervical injections).
2. Imaging Guidance: Using fluoroscopy (live X-ray) or ultrasound, the doctor will guide the needle precisely into the epidural space.
3. Injection: A mixture of steroid and anesthetic is injected. The entire process usually takes about 15–30 minutes.
4. Post-Procedure Monitoring: You’ll be monitored briefly for any side effects, then discharged the same day.

Most people can resume normal activities within 24 hours, although strenuous activity should be avoided for a day or two.

How Effective Are Epidural Steroid Injections?

Effectiveness can vary. Some people experience significant relief, while others may only get partial or temporary improvement. In general:

• About 50–80% of patients get meaningful pain relief.
• Relief may last from a few weeks to several months.
• In some cases, a series of injections (usually no more than 3 per year) is recommended to maintain relief.

The greatest benefit is often in breaking the cycle of pain, allowing patients to better participate in physical therapy, improve mobility, and regain quality of life.

Are There Risks or Side Effects?

As with any medical procedure, there are risks—though they’re relatively low when performed by experienced professionals. Possible side effects include:

• Mild soreness or bruising at the injection site
• Temporary increase in pain
• Headache (especially if spinal fluid is accidentally punctured)
• Insomnia or flushing (from the steroid)
• Infection (very rare)
• Bleeding or nerve damage (extremely rare)

People with diabetes may notice a temporary spike in blood sugar levels, and those with osteoporosis should talk to their doctor about bone health, as steroids can weaken bones with repeated use.

Who Should Consider an ESI?

Epidural steroid injections are not for everyone. They are usually considered when:

• Conservative treatments like physical therapy and medications have not provided adequate relief.
• Imaging studies (like MRI) show a clear source of nerve compression or inflammation.
• Surgery is not currently recommended or the patient prefers to delay it.

ESIs are most effective for nerve-related pain (like sciatica or radiculopathy) and less effective for pain from mechanical causes (like muscle strain or arthritis).

Myths and Misconceptions

Let’s clear up a few common misunderstandings:

“It’s just a temporary Band-Aid.”

While it’s true that ESIs don’t cure the underlying problem, they can provide enough relief to avoid or delay surgery, improve function, and support other treatments like rehab or weight loss.

“Steroids are dangerous.”

When used sparingly and under medical supervision, corticosteroids are generally safe. The risks from a few localized injections are far lower than long-term oral steroid use.

“If one doesn’t work, there’s no point in trying again.”

Some patients don’t feel relief from the first injection, but may respond to a second or third. Sometimes it takes finding the right type of injection or refining the target area.

Final Thoughts

Chronic back and neck pain can be incredibly frustrating and limiting—but you’re not without options. Epidural steroid injections offer a non-surgical way to reduce inflammation, relieve nerve pain, and help you move forward with your recovery.

They aren’t a one-size-fits-all solution, but when used appropriately and combined with other treatments like physical therapy, lifestyle changes, and good spinal care, they can play a valuable role in managing long-term pain.

If you’re considering an epidural steroid injection, talk to your spine specialist or pain management provider. They can help you determine whether it’s the right step for your unique condition and health goals.