Epidural Steroid Injection For Back Pain: What You Need to Know Before Getting One

July 20, 2023Kolton Opdahl
Back & Neck PainRegenerative MedicineSteroid Injection

A lot of individuals tend to postpone or extend their spinal surgery. If you’re reading this piece, it’s probable that you belong to this group of individuals. During the period when you are postponing surgery or waiting for the scheduled date, your healthcare provider might recommend a pain management regimen to help you cope until the day of surgery or to assist with pain management as you consider whether or not to undergo the procedure. This may include an epidural steroid injection.

While there are various treatments available for back pain, including physical therapy, medication, and surgery, epidural steroid injections (ESIs) have become an increasingly popular treatment option.

ESIs are a minimally invasive procedure that involves injecting steroids into the epidural space surrounding the spinal cord. The steroids used in ESIs are a type of corticosteroid that works to reduce inflammation and alleviate pain. This blog post will explore the use of epidural steroid injections for lower back pain relief, the actual procedure, potential risks and side effects, and what are your alternative options for ESIs.

What is an Epidural Steroid Injection?

ESIs are a type of injection that involves delivering a corticosteroid medication directly into the epidural space. This space surrounds the spinal cord and nerve roots. The medication used in ESIs is a synthetic form of cortisol.

Corticosteroids work to reduce inflammation and swelling, which can help alleviate pain and other symptoms associated with back pain. The most common corticosteroids used in ESIs include methylprednisolone, triamcinolone, and betamethasone.

It is important to note that ESIs are not the same as cortisone injections. While both treatments involve the use of corticosteroids, ESIs target the epidural space around the spinal cord, while cortisone injections target other areas of the body.

Why are Epidural Steroid Injections Used for Back Pain?

ESIs are used to treat a variety of conditions that cause back pain. This can include herniated discs, spinal stenosis, and degenerative disc disease. These conditions can cause inflammation and swelling in the epidural space. And can put pressure on the nerves in the spine and cause pain.

ESIs work to reduce inflammation and swelling in the epidural space. This can alleviate pressure on the nerves and provide pain relief. Additionally, the steroids used in ESIs can help reduce the production of pain-causing chemicals in the body. This can further reduce pain and improve a patient’s quality of life. ESIs are often used as a conservative treatment option for back pain before more invasive treatments, such as surgery, are considered.

The Epidural Steroid Injection Procedure

ESIs are typically performed on an outpatient basis and take about 15-30 minutes to complete. Before the procedure, patients will receive a local anesthetic to numb the area around the injection site.

Once the patient is numb, the healthcare provider will use fluoroscopy or ultrasound to guide the injection needle into the epidural space. Fluoroscopy is a type of X-ray imaging that allows the healthcare provider to visualize the needle’s position in real-time. While ultrasound uses high-frequency sound waves to create images of the body’s internal structures.

Once the needle is in place, the corticosteroid medication is injected into the epidural space. After the injection, the healthcare provider will monitor the patient for a short period to ensure there are no complications.

Recovery and Follow-Up Care

After an ESI, patients can typically go home the same day and resume normal activities within a few days. However, patients should avoid strenuous activities and heavy lifting for a few days after the procedure.

Patients may experience some side effects after the injection, including mild pain or numbness at the injection site, headache, or flushing of the face. These side effects typically resolve within a few days and can be managed with over-the-counter pain medications.

Patients may also experience some improvement in their symptoms immediately after the injection. However, it may take a few days or weeks for the full effect of the injection to be felt. It is important for patients to follow up with their healthcare provider after the injection to monitor their progress and determine if additional injections are needed.

Most patients can receive up to three ESIs per year, depending on their specific condition and response to the injections. Patients who do not experience significant improvement after the first injection may require additional injections to achieve maximum pain relief.

Risks of an Epidural Steroid Injection

ESIs are generally safe and well-tolerated by most patients. However, as with any medical procedure, there are some risks and potential side effects.

The most common side effects of ESIs include mild pain or numbness at the injection site, headache, or flushing of the face. These side effects typically resolve within a few days and can be managed with over-the-counter pain medications.

More serious complications from ESIs are rare but can occur. These complications may include infection, bleeding, nerve damage, or allergic reactions to the medication used in the injection. Patients should notify their healthcare provider immediately if they experience any unusual symptoms after the injection, such as severe pain, difficulty breathing, or swelling at the injection site.

epidural steroid injection

Who is a Candidate for an Epidural Steroid Injection?

ESIs are typically recommended for patients who have not found relief from other conservative treatments for their back pain, such as physical therapy, medication, or chiropractic care.

An epidural steroid injection may be a good treatment option for patients with herniated discs, spinal stenosis, or degenerative disc disease. ESIs may also be recommended for patients who are not good candidates for surgery due to their age, medical history, or other factors.

However, ESIs may not be recommended for patients with certain medical conditions. This could include diabetes, high blood pressure, or bleeding disorders. Patients should discuss their medical history with their healthcare provider to determine if ESIs are a safe and appropriate treatment option.

Alternative to Epidural Steroid Injections

PRP (Platelet-Rich Plasma) and prolotherapy are two effective alternative treatment options for chronic back pain that have gained popularity in recent years. Both treatments offer a non-surgical, non-pharmacological approach to pain management that can provide long-lasting relief.

PRP Therapy

PRP therapy involves injecting concentrated platelets from the patient’s own blood into the affected area. These platelets contain growth factors that stimulate the body’s natural healing processes, promoting tissue regeneration and reducing inflammation. (Read more details about Platelet-Rich Plasma)


In prolotherapy, a solution of dextrose and anesthetic is injected into the affected area. This creates a localized inflammatory response that triggers the body’s healing mechanisms. (Read more details about prolotherapy)

Advantages of PRP Therapy and Prolotherapy

One of the key advantages of PRP and prolotherapy over epidural steroid injections is that they are minimally invasive and carry few risks. While ESIs can have side effects such as nerve damage, infection, and bleeding, PRP and prolotherapy have a low risk of complications and are generally well-tolerated by patients.

Another benefit of these treatments is that they can provide long-lasting relief. While ESIs provide temporary relief, PRP and prolotherapy can stimulate the body’s natural healing mechanisms, leading to long-term pain reduction and improved function.

Ultimately, the decision to pursue PRP or prolotherapy as an alternative to epidural steroid injections should be made in consultation with a healthcare provider. A thorough evaluation of the patient’s condition, medical history, and treatment goals is necessary to determine if these treatments are appropriate and likely to be effective.

PRP Therapy vs Epidural Shots

Cortisone injections are known to offer quick pain relief in the affected tendon or joint space. This allows patients to resume their regular activities with little to no pain. However, the downside of cortisone injections is their potent side effects that may lead to the deterioration of ligaments, bones, and joints, offering only temporary relief until its effect wears off. Furthermore, cortisone injections are limited in their application due to their side effects. And do not possess any healing properties, which can eventually lead to more damage in the long run.

On the other hand, PRP takes a longer time to heal and provide pain relief. But offers a more comprehensive solution by simultaneously providing healing to the injured tendon and joint space. PRP utilizes the body’s natural healing process by injecting concentrated platelets from the patient’s own blood. PRP offers long-term benefits, as it does not merely mask pain with temporary relief, but promotes healing of the injured area while offering pain relief throughout the process.


Epidural steroid injections are a minimally invasive treatment option for patients with back pain. While they are not a cure for back pain, they can provide temporary pain relief and improve function for many patients.

Patients should work with their healthcare provider to develop a comprehensive treatment plan that includes ESIs and other conservative treatments to address the root cause of their back pain.

If you are suffering from back pain and want to learn more talk to your healthcare provider. They will help to determine the safest and appropriate treatment option for your specific condition.

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