Pain Management Procedures
Epidural Steriod Injections
Epidural Steroid Injections
What is an epidural steroid injection?
An epidural steroid injection places anti-inflammatory medication in the epidural space around irritated spinal nerves. It is intended mainly for nerve-related pain, such as pain that shoots, burns, tingles, or travels into an arm, around the chest wall, or down a leg. It is not a cure for a herniated disc, arthritis, or spinal narrowing, but temporary symptom relief may make movement, sleep, and rehabilitation easier.
Which approaches are used?
Interlaminar injection: medication enters the epidural space between two vertebrae and can spread across a broader area. It may be performed in the cervical, thoracic, or lumbar spine.
Transforaminal injection: medication is directed near a particular nerve root as it exits the spine. This is often chosen for one-sided radiating pain.
Caudal injection: medication enters through an opening near the bottom of the sacrum and travels upward in the lower epidural space. It may be used for low-back, buttock, or leg symptoms, including in some patients with prior lumbar surgery.
Selective nerve root block: a small, targeted injection near one nerve root is used mainly to determine whether that nerve is causing the symptoms; medication may also provide temporary relief.
What happens during the procedure?
You usually lie face down. The skin is cleaned and numbed. Fluoroscopy guides the needle, and contrast dye is commonly used to verify that medication will flow in the intended area. The steroid and local anesthetic are then injected. Pressure, tingling, or a temporary reproduction of the familiar radiating pain can occur.
Recovery and results
The treated area may be sore, and pain can briefly increase before improving. Steroid benefit commonly begins within two to seven days. Relief may last days to months, and some patients receive little or no benefit. The procedure is usually one part of a broader plan rather than a stand-alone cure.
Important safety information
Risks include bleeding, infection, spinal headache, medication reaction, temporary weakness or numbness, elevated blood sugar, and very rare nerve or spinal cord injury. The FDA has warned that rare but serious neurologic events - including stroke, paralysis, vision loss, and death - have occurred after epidural corticosteroid injection. Corticosteroids are not FDA-approved specifically for epidural use, even though the procedure is common. Your clinician will discuss why a particular approach and medication are being considered.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.