What to Expect from an Injection for Pinched-Nerve Pain
An epidural steroid injection (ESI) places an anti-inflammatory steroid medication, usually with a numbing medicine, into the epidural space, the area around the spinal nerves just inside the spinal canal. It is used to calm irritated, inflamed nerve roots that cause pain shooting into the arm or leg. It is one of the most common procedures in pain medicine. The goal is to reduce pain enough to let you move, sleep, and take part in physical therapy.
Who May Be a Candidate
Lumbar radiculopathy (sciatica) or cervical radiculopathy from a herniated disc or narrowed nerve opening.
Spinal stenosis with leg or arm symptoms.
Pain that has lasted several weeks or is severe despite medications and physical therapy.
ESI is less helpful for back or neck pain without arm or leg symptoms.
Types of Epidural Injections
Transforaminal: Medication is placed right next to a specific nerve root where it exits the spine. It is very targeted and is often used for one-sided leg or arm pain.
Interlaminar: Medication is placed into the epidural space from the back, between two vertebrae, and spreads to both sides.
Caudal: Medication enters through a small opening at the base of the spine, near the tailbone. It is often used after prior back surgery.
Before Your Procedure
Blood thinners: Tell us about every blood thinner you take. Some need to be stopped for several days before the injection, always in coordination with the doctor who prescribed them. Never stop a blood thinner on your own.
Diabetes: Steroids can raise blood sugar for a few days. Plan to check your levels more often.
Infection or illness: Let us know if you have a fever, an active infection, or are taking antibiotics. We may reschedule.
Pregnancy: Tell us if you are or might be pregnant, since x-ray is used.
Transportation: If you receive sedation, you will need a driver.
The Day of the Procedure
You lie on your stomach (or sometimes on your side) on the procedure table.
The skin is cleaned, and a small amount of numbing medicine is injected.
Using live x-ray (fluoroscopy), a thin needle is guided to the epidural space. Contrast dye confirms the correct spot.
The steroid and numbing medicine are injected.
The injection itself usually takes 10 to 20 minutes, and you will be monitored for a short time afterward.
After Your Procedure
Your arm or leg may feel numb or weak for a few hours from the numbing medicine. Walk carefully.
Rest for the remainder of the day, then return to normal activity as tolerated.
Some soreness at the injection site is common for a day or two.
The steroid usually starts to work within 2 to 7 days. Relief can last weeks to months.
Keep a pain diary so we can judge how well it worked.
Continue your physical therapy and home exercises.
Risks and Safety
Serious complications are rare when the procedure is done with image guidance by an experienced physician.
Common: Soreness, a temporary increase in pain, facial flushing, trouble sleeping, or elevated blood sugar for a few days.
Uncommon: A headache from a small spinal fluid leak, which usually resolves with rest and fluids.
Rare: Infection, bleeding, nerve injury, or allergic reaction.
Very rare but serious: Stroke or spinal cord injury. The FDA has warned about these rare events, and national safety guidelines use specific techniques and medication choices to reduce the risk.
Steroid injections are usually limited to a few per year to reduce side effects such as bone thinning.
How Strong Is the Evidence?
Lumbar radiculopathy from a disc herniation: Level II (Moderate) · ASIPP epidural injection guidelines (Manchikanti et al., Pain Physician 2021)
Cervical radiculopathy: Level II–III · ASIPP guidelines
Central lumbar spinal stenosis: Level I (limited added benefit) · LESS trial (Friedly et al., N Engl J Med 2014)
Safety practices: Consensus · Multisociety safeguards to prevent neurologic complications (Rathmell et al., Anesthesiology 2015)
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Alternatives
Alternatives include continuing physical therapy and medications, selective nerve root blocks, minimally invasive spine procedures, neuromodulation, and surgical evaluation. We review the benefits and trade-offs of each with you.
Conditions This May Help
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
