Epidural steroid injections (ESIs) are a common treatment for chronic back pain caused by nerve irritation that has not responded to other noninvasive treatments. It involves injecting medication into the epidural space surrounding the spinal cord to reduce inflammation and irritation of the spinal nerves.
This treatment helps alleviate nerve pain and provides temporary relief that may last for weeks or months. In some cases, ESI can lead to long-term pain relief.
UPMC specialists take a comprehensive, multidisciplinary approach to spine care and pain management, offering the latest and safest treatments for spinal nerve pain.
What Are Epidural Steroid Injections?
Epidural steroid injections (ESIs) are a treatment designed to relieve symptoms of irritated or inflamed spinal nerves. During the procedure, a doctor injects anti-inflammatory medication into the epidural space — the area surrounding the spinal cord.
ESIs are commonly used for chronic spinal nerve pain that does not improve with conservative treatments. Reducing nerve inflammation can provide temporary pain relief for weeks or months. In some cases, ESIs result in lasting pain relief.
What's the difference between a cortisone shot and an epidural steroid injection?
Both cortisone shots and ESIs use the same steroid medication to treat inflammation and pain. However, ESIs are administered into the epidural space around the spinal cord to target nerve inflammation at its source, while cortisone shots are typically injected into muscles, joints, or soft tissues.
Types of epidural steroid injections
The type of ESI depends on the location of nerve pain:
- Cervical ESI – Targets nerve pain in the neck.
- Lumbar ESI – Treats nerve pain in the lower back.
- Thoracic ESI – Addresses nerve pain in the mid- and upper back.
Different techniques can be used to access the epidural space:
- Caudal ESI – Injected near the tailbone to reach the lowest spinal nerves.
- Interlaminar ESI – Delivered between the laminae of the spinal vertebrae.
- Transforaminal ESI – Administered through the nerve root exit points (foramen).
Conditions we treat with ESI
ESIs are used to treat various conditions, including:
Why would I need an epidural steroid injection?
You may need an ESI if you experience persistent spinal nerve pain that does not improve with conservative care.
Am I a candidate for ESI?
You may be a candidate for an ESI if you experience:
- Bowel or bladder control issues (incontinence).
- Difficulty walking, sitting, standing, or grasping objects.
- Numbness, tingling, pain, or weakness in the arms or legs.
Alternatives to ESI
Alternatives to ESIs include:
- Heat and ice therapy.
- Over-the-counter pain medications.
- Physical therapy.
- Surgery (for severe or persistent conditions).
Risks and Complications of an Epidural Steroid Injection
ESIs are generally safe, but complications may include:
- Accidental medication leakage into the bloodstream or nearby nerves.
- Allergic reactions.
- Bleeding or infection at the injection site.
- Headache from spinal fluid leakage (rare).
- Low blood pressure.
- Nerve damage.
- Temporary loss of bladder or bowel control.
What are the long-term side effects of ESI?
Long-term side effects are rare but may include:
- Chronic pain.
- Paralysis (in extremely rare cases).
- Permanent nerve damage.
- Spinal bone weakening.
What to expect from an epidural steroid injection
Preparing for your ESI
Before your procedure, your doctor will:
- Discuss any medications you are taking and whether you need to stop certain medications (such as blood thinners).
- Order necessary tests, such as blood tests, MRI, or X-rays.
- Perform a physical exam and review your medical history.
On the day of your procedure:
- Arrange for someone to drive you home after the procedure.
- Bring a photo ID and health insurance card.
- Leave valuables at home.
During the procedure
An ESI is an outpatient procedure, typically lasting around 30 minutes, followed by a short recovery period.
During the procedure:
- You will lie on a procedure table.
- The doctor may administer a mild sedative and local anesthesia to numb the area.
- Using X-ray guidance, the doctor will insert a needle into the epidural space.
- A contrast dye may be injected to ensure the correct placement.
- The steroid medication is then injected.
After the procedure, a small bandage is applied, and you will be monitored for a short time.
Recovery after an ESI
- Avoid strenuous activity for 24 hours.
- Follow your doctor’s guidance on resuming normal activities.
- You may feel mild numbness or tingling, which usually resolves within a few hours.
When to call your doctor
Seek medical attention if you experience:
- Difficulty walking or maintaining balance.
- Fever above 100°F.
- New or worsening numbness, tingling, or weakness.
- Redness, swelling, or drainage at the injection site.
- Severe pain that does not improve.
How long does an ESI last?
Most people experience relief within three to seven days. Pain relief can last weeks or months, improving mobility and quality of life.
What is the success rate of ESI?
While ESIs provide relief for many patients, results vary:
- About 50% of patients experience significant pain relief.
- Most doctors limit ESIs to three injections per year due to potential side effects.
- Some patients may require repeat injections.
Why Choose UPMC for an Epidural Steroid Injection?
UPMC specialists use state-of-the-art techniques and the least invasive approaches to effectively manage spinal nerve pain. Our expert team focuses on safe, advanced procedures that promote better outcomes, improve function, and enhance your overall quality of life.
By UPMC Editorial Staff. Last reviewed on 2025-05-16.
