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Epidural Steroid Injection

An epidural steroid injection can help relieve pain in the neck, arm, lower back and leg (sciatica) caused by swelling and irritation of the spinal nerves.

An epidural steroid injection involves bathing the irritated spinal nerves with a steroid (anti-inflammatory medication) and a local anesthetic (numbing medication).

During this treatment, medication is placed into the epidural space where the spinal nerves exit the spine. If the pain is significantly improved after the injection, no further injection is usually needed. Pain relief may be very long-lasting. However, it is not unusual to need more than one injection to get pain relief and/or for a longer benefit.

Procedure overview (PDF) ›

Patient guidelines (PDF) ›

What is the goal of epidural steroid injection?

The goal is to provide pain relief so that you are able to resume normal activities. In many cases, we will prescribe a course of physical therapy to help you return to a normal level of activity.

What happens before treatment?

You will be escorted to a room where a nurse will conduct a pre-procedure interview.

The physician who will perform the injection reviews your medical history, previous imaging studies, current medications and physical exam results in order to help plan the best approach for the injection. If you have not had a physical exam prior to the injection, the physician will perform an exam at this time.

What happens during the procedure?

You will remain awake during the entire process. Blood pressure, heart rate and breathing are continually monitored.

After you are lying face down on the procedure table, the injection site is cleansed with an antiseptic.

This procedure involves inserting a needle through the skin, muscle and soft tissues, so there is some slight discomfort involved. An injection of local anesthetic (numbing medication) will be administered in the area where you are experiencing pain.

The physician then directs a needle with the use of X-ray guidance and deposits the medication. This procedure takes approximately 30 minutes.

Should I limit my activity or change my diet after the injection?

No. Unless your doctor tells you otherwise, you may return to your usual activities and resume your normal diet immediately after the injection.

Are there any side effects caused by epidural steroid injection?

Side effects are uncommon following epidural steroid injection.

  • Immediately after the injection, you may feel that your pain is gone or is much less. This pain relief is often from the local anesthetic and will usually only last a few hours, followed by return of your usual pain. Pain relief from the steroid medication usually takes several days to appear.
  • You may experience mild pain at the site of injection for several days. You may also experience a temporary increase in your usual pain after the injection. You can apply ice to the area for as long as 15 minutes, three to four times a day.
  • You may experience some dizziness during or soon after the injection.

For diabetic patients

It is important for you to know that if you have diabetes, the steroid can elevate your blood sugar for up to two weeks after the injection. If you have diabetes and regularly check your own blood sugar, you should check your blood sugar more often during the first several days after an epidural steroid injection.

Please talk with the doctor who helps to manage your diabetes for instructions in how to change your diet and/or diabetes medication if your blood sugar is elevated.

Are there any restrictions after epidural steroid injection?

Yes. You should follow these restrictions after the procedure:

  • Do not drive for the remainder of the day.
  • Do not take a tub bath or soak in water (pool, hot tub) for 24 hours after the procedure.
  • Allow three days after the procedure before resuming physical therapy.

What medications are used for epidural steroid injection?

Epidural steroid injections are performed with a mixture of different medications given for specific reasons.

  • Lidocaine or bupivacaine are local anesthetics that are used to numb the area of injection; this numbness usually wears off within two to six hours.
  • Triamcinolone (Kenalog®) is a steroid used to treat inflammation and pain. The effects of this steroid may take up to 10 days to appear.
  • Lopamidol, an X-ray contrast agent, may be injected into the area to confirm correct placement.

When should I call my doctor?

You should call your doctor immediately if any of the following occurs:

  • Swelling, redness, bleeding or discharge from the site of the injection
  • A fever greater than 100 ˚F
  • New or worsening back or neck pain
  • New numbness or weakness in your arms or legs
  • Difficulty with urination after the injection, such as suddenly losing control of your bladder
  • Difficulty with bowel movements after the injection, such as suddenly losing control of your bowels
  • You develop a new headache after the procedure
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