Epidural steroid injections can deliver an anti-inflammatory steroid into the epidural space around the spinal cord. It is unclear why this might cause a temporary increase in pain before bringing relief, but it may involve the irritation of nerve roots extending from the spine.
Epidural steroid injections can offer improvements to a person in terms of quality of life, but they do not work immediately and their effects are temporary and not curative.
This article examines who might experience increased pain following epidural steroid injections, the advantages and disadvantages of injections, risks, how to prevent pain, and frequently asked question.
Increased pain following epidural steroid injections is well documented.
One 2022 publication suggests that after a cervical injection, up to 18% of people feel increased radiating pain for a few days following the procedure.
The reasons for an increase in pain are not well documented. The epidural space, where the doctor injects the steroid, is small. The introduction of steroid fluid into this space, where nerves are already inflamed, may temporarily increase pressure, irritating spinal nerves.
Anyone undergoing an epidural steroid injection may experience a temporary increase in pain following the procedure.
A 2022 review states that the effects of steroid injections for back pain relief are unpredictable. They usually do not completely cure the pain, and the effects are not immediate, but they can improve the quality of life.
A 2019 study comparing epidurals with IV anesthesia showed similar results on back pain. Researchers found that neither method of pain relief triggered a significant increase in risk of back pain in early postpartum or 6 months after delivery. Results were similar between the two groups.
Sciatica after epidural
There is a small risk of injury to a nerve during the injection that may trigger sciatica. These side effects are usually short term and typically resolve within a few days.
If sciatica existed before the injection, the injection might offer relief for weeks to a year. Epidural steroid injections do not usually last longer than a year and require repetition over time. Sometimes epidural steroid injections may need to be part of a more extensive treatment program.
Pros and cons of epidural
There are advantages and disadvantages to consider before deciding on an epidural steroid injection. A few things to consider include:
Benefits of epidural
- temporary to longer pain relief
- improved ability to move
- may help doctors pinpoint the cause of pain, often a problem with spinal pain
- may help avoid surgery
Drawbacks of epidural
- temporary increase in pain
- headache is rare but possible
- reaction to the steroid
- infection at the injection site
- bleeding of a knicked blood vessel
- temporary paralysis of the nerves leading to the bowel or bladder
- minimal low-level radiation from X-ray guidance
Major risks from this procedure are very rare. Complications that might occur include:
- tingling or prickling sensations in limbs
- blood clots
- epidural abscess
- inflammation of the membrane that protects the spinal cord (arachnoiditis)
- an injection placed incorrectly (subdural/subarachnoid injection)
- an injection placed into an artery
Can you prevent pain after an epidural?
The doctor will inject a numbing anesthetic that will numb the area for several hours along with the steroid. The area may be sore when it wears off, and pain may increase. Talk with the doctor in advance about taking an over-the-counter medication.
An ice pack applied three to four times a day may provide relief.
Plan to rest at home. Discuss with the doctor if there are any movement restrictions. It may temporarily be more comfortable to lie on one side or the other with a pillow between the knees.
Below are the answers to some frequently asked questions about epidural steroid injections.
How long does it take for an epidural steroid injection to start working?
It generally takes 2–3 days for the steroid to begin working. During this time, pain may increase temporarily.
Why does my back feel worse after an epidural?
Pain may increase temporarily due to irritation of the nerves in the spine. The steroid injection introduces fluid into a compressed space, the epidural space, where inflammation may have already been present.
This 2021 study looked at how long localized pain at the injection site lasted after an epidural. Pain for most people involved in the study seemed to resolve in less than 48 hours, with a few people reporting pain took under 3 months to resolve.
Researchers speculated that some factors such as positioning during the epidural and age may play a role in post-op pain. The authors noted that pain occurred more in those under age 50.
What can you do when epidural steroid injections don’t work?
For some people, it may take multiple steroid injections to feel results.
When epidural steroid injections do not work, the doctor may discuss other therapies, including surgical options. A person’s individual circumstances will determine which therapeutic options are suitable.
Pain following epidural steroid injections sometimes occurs, typically lasting around 3 days before subsiding. At that point, pre-injection pain levels should be lower.
Pain may increase when steroid fluid is introduced to inflamed spinal nerves in a compressed space. The steroid is a powerful anti-inflammatory medication that helps resolve inflammation and pain.
Following epidural steroid injections, a person can typically treat increasing pain with rest, over-the-counter pain relievers, and ice packs.