Understanding Epidural Steroid Injections for Back Pain Relief

Q: How long does relief from an epidural steroid injection last?

The duration of relief varies from patient to patient. Many patients experience improvement that lasts for several weeks to a few months. Some patients find that a series of injections combined with physical therapy produces more lasting benefit. For patients whose pain returns after ESIs, other treatments such as radiofrequency ablation may be considered.

ReleviiMed
1 day ago
8 min read

Back pain is one of the most common reasons people visit a physician, and one of the most common reasons patients seek care from a pain management specialist. When back pain is caused by nerve inflammation, a herniated disc, or spinal stenosis, a treatment called an epidural steroid injection may offer significant relief.

If your doctor has recommended an epidural steroid injection or you have been wondering whether it might help your symptoms, this article will walk you through what the procedure involves, which conditions it treats, what to expect before and after, and what the results typically look like.

Key Takeaways

Epidural steroid injections (ESI) deliver anti-inflammatory medication directly into the epidural space around the spinal cord, targeting the source of nerve-related pain.
They are commonly used to treat sciatica, herniated discs, spinal stenosis, and radiculopathy, among other conditions.
Most patients experience relief that lasts for weeks to months, and the procedure is performed as an outpatient treatment using imaging guidance for precision.

What Is an Epidural Steroid Injection?

An epidural steroid injection is a procedure in which a corticosteroid medication, combined with a local anesthetic, is delivered directly into the epidural space. The epidural space is a layer of tissue that surrounds the spinal cord and the nerve roots that branch off it. When nerve roots in this space become inflamed due to pressure or injury, they generate pain that can be felt locally in the back or neck, or radiate into the arms, legs, or buttocks.

By delivering corticosteroid medication to this exact location, an ESI reduces inflammation around the affected nerves, which can relieve pain, decrease numbness and tingling, and improve function.

It is important to understand that an ESI is not a cure for the underlying structural problem. If you have a herniated disc, for example, the disc does not disappear after an injection.

What the injection addresses is the inflammatory response around that disc that is causing nerve pain. For many patients, reducing that inflammation is enough to allow them to function better and participate more fully in their daily lives and in physical therapy or rehabilitation.

What Conditions Are Treated with Epidural Steroid Injections?

Epidural steroid injections are most effective for pain that has a nerve-involvement component, particularly pain that radiates from the spine into the extremities. The conditions most commonly treated include:

Sciatica

Sciatica refers to pain that travels along the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. It is typically caused by a herniated disc or bone spur pressing on the nerve root. The radiating pain, numbness, and weakness that sciatica produces can be debilitating, and ESIs are a well-established treatment option for this condition.

Herniated and Bulging Discs

When the soft material inside a spinal disc pushes outward and presses against a nerve, it causes pain that can be severe. ESIs reduce the inflammation that results from this compression, helping to relieve both the local back pain and any pain that travels down an arm or leg.

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal cord and nerve roots. It is a common cause of lower back pain, leg pain, and difficulty walking in older adults. ESIs can help reduce inflammation and relieve the nerve pain associated with this condition, though the structural narrowing itself remains.

Degenerative Disc Disease

As the spine ages, the discs between vertebrae can lose height and water content, a process called degeneration. This can lead to chronic lower back or neck pain, sometimes with associated nerve symptoms. ESIs can address the inflammatory component of this pain.

Radiculopathy

Radiculopathy is the medical term for nerve root pain. It can occur at any level of the spine and produces symptoms in the area supplied by that specific nerve root, including shooting pain, numbness, burning, or weakness in an arm or leg. ESIs are a first-line interventional treatment for radiculopathy when conservative measures have not provided sufficient relief.

Failed Back Surgery Syndrome

Patients who have undergone spine surgery and continue to experience significant pain may benefit from ESIs as part of their ongoing pain management. The procedure helps address residual nerve inflammation that sometimes persists after surgery.

Cervical Pain with Arm Symptoms

ESIs are not limited to the lumbar spine. Cervical epidural steroid injections are also performed for patients with neck pain that radiates into the arms, often due to disc herniation or foraminal stenosis at the cervical level.

Types of Epidural Steroid Injections

There are three main approaches used to deliver medication into the epidural space, and the choice depends on the location and nature of your pain:

Interlaminar ESI: The medication is delivered through the back of the spine into the epidural space. This is the most commonly performed approach for patients with diffuse spinal inflammation.
Transforaminal ESI: The medication is delivered through the neural foramen, the opening through which nerve roots exit the spinal canal. This approach is more targeted and is often used when a specific nerve root is identified as the primary pain generator.
Caudal ESI: The medication is delivered through an opening at the base of the sacrum. This approach is often used for lower lumbar or sacral nerve root involvement.
Dr. Ybarra selects the most appropriate approach based on your imaging findings and the specific distribution of your symptoms.

What to Expect: Before, During, and After Your Injection

Before the Procedure

Your consultation will include a review of your symptoms, medical history, and any imaging studies. It is important to inform the care team about all medications you are taking, particularly blood thinners, as these may need to be temporarily adjusted before the procedure. You may also be asked to avoid eating or drinking for a period of time before your appointment if sedation will be used.

Arrange for someone to drive you home after the procedure, particularly if sedation is involved.

During the Procedure

You will be positioned on the procedure table, typically face down for lumbar injections. The skin over the injection site will be cleaned and numbed with a local anesthetic. Dr. Ybarra uses fluoroscopic (X-ray) or ultrasound imaging guidance throughout the procedure to confirm precise needle placement before any medication is injected. The use of imaging guidance is a critical safety and efficacy measure that ensures the medication reaches the correct location.

The procedure itself typically takes 15 to 30 minutes, though you will remain in the recovery area for a period of monitoring afterward. Many patients find the procedure more comfortable than they anticipated.

At ReleviiMed, conscious sedation is available for patients who are anxious about the procedure or who prefer additional comfort. This is an option that not all pain clinics in San Antonio offer.

After the Procedure

It is common to experience some mild soreness at the injection site for a day or two. You may also notice a temporary increase in pain as the local anesthetic wears off, before the steroid begins to take effect. This temporary increase, sometimes called a "steroid flare," is normal and typically resolves within a day or two.

You will receive specific post-procedure instructions, including activity restrictions for the first 24 hours. Most patients are able to return to light activity the following day.

Pain relief from an ESI typically begins within a few days to one week as the steroid takes full effect. The duration of relief varies from patient to patient, but many patients experience improvement that lasts for several weeks to several months.

What Kind of Results Can Patients Expect?

Epidural steroid injections are not guaranteed to eliminate pain entirely or permanently. Their goal is to reduce inflammation around affected nerves sufficiently to allow the patient to function better, engage in physical therapy, and have a meaningful period of reduced pain.

Results vary by patient and condition. Some patients experience significant relief after a single injection. Others benefit most from a series of injections over time. If ESIs provide only temporary benefit and the underlying condition continues to produce pain, other treatments, such as radiofrequency ablation or spinal cord stimulation, may be considered as the next step.

A series of up to three epidural steroid injections in a given spinal region may be recommended within a 12-month period, depending on the patient's response and clinical needs.

Costs and Insurance Coverage for ESIs in San Antonio

Epidural steroid injections are covered by most major health insurance plans, including Medicare, when they are considered medically necessary for a documented diagnosis. The prior authorization process varies by insurer and by the specific type of injection being performed.

Patients without insurance coverage may pay out of pocket. Costs vary depending on the type of injection, the spinal level treated, and whether sedation is used. The ReleviiMed team can provide cost information and help you understand your insurance coverage before scheduling.

ESIs at ReleviiMed in San Antonio

At ReleviiMed, epidural steroid injections are performed by Dr. Manuel Ybarra, a fellowship-trained, board-certified anesthesiologist with subspecialty board certification in Pain Medicine. Dr. Ybarra trained at Rush University Medical Center and has been providing expert pain care to patients in San Antonio, Schertz, Cibolo, New Braunfels, Guadalupe County, and throughout Northeast San Antonio for years.

Every injection at ReleviiMed is performed using imaging guidance for accuracy and safety. Sedation is available for patients who prefer it. The practice's family-like environment ensures that patients feel comfortable and cared for at every step of the process.

If you are experiencing back pain, sciatica, or nerve pain that has not responded to conservative treatment, schedule a consultation with Dr. Ybarra at ReleviiMed to find out whether an epidural steroid injection is right for you. Call (210) 299-7770 or book online.

Frequently Asked Questions

How many epidural steroid injections can I receive?

The number of injections appropriate for any individual depends on their response to treatment and clinical needs. A series of up to three injections in a given spinal region within a 12-month period is common practice. The goal is always to use the minimum number of injections needed to achieve the desired outcome. Your care team will guide you based on your specific situation and your body's response.

How long does relief from an epidural steroid injection last?

The duration of relief varies from patient to patient and depends on the underlying condition. Many patients experience improvement that lasts for several weeks to a few months. Some patients find that a series of injections, combined with physical therapy, produces more lasting benefit. For patients whose pain returns after ESIs, other treatments such as radiofrequency ablation may be considered.

Are epidural steroid injections safe?

When performed by a trained physician using imaging guidance, epidural steroid injections are considered a safe procedure with a well-established track record. As with any medical procedure, there are potential risks, including temporary soreness, infection, and in rare cases, more significant complications. Dr. Ybarra will discuss the risks and benefits with you fully during your consultation.

Will I be sedated during an epidural steroid injection?

Sedation is not always required, but it is available at ReleviiMed for patients who prefer it. Many patients undergo ESIs with only local anesthetic to numb the injection site and find the procedure comfortable and manageable. If you have concerns about discomfort, the team can discuss sedation options with you during your consultation.

Can an epidural steroid injection fix a herniated disc?

No. An ESI does not repair a herniated disc or change its structural position. What it does is reduce the inflammation around the affected nerve root caused by the herniated disc, which can significantly reduce the pain and neurological symptoms associated with it. Some herniated discs resolve on their own over time, and an ESI can help manage symptoms during that process.