What are the side effects of steroid injections for back pain

A lumber epidural steroid injection is a treatment to relieve pain in your lower back or legs caused by inflammation of the nerves in your spine.

Steroids, also called corticosteroids, are medications that bring down inflammation. Your doctor gives the injection into the epidural space around the spinal cord in your lower back.

You might get a lumbar steroid injection if you have pain from:

  • a herniated disc
  • spinal stenosis
  • degenerative spine disease
  • bone spurs

Everyone responds to the procedure differently. In general, a lumbar epidural steroid injection can be a bit uncomfortable, but it shouldn’t be painful. You can ask your doctor for a mild sedative to relax you before the procedure.

Your doctor will first inject a local anesthetic into the skin on your back to numb the area. The injection might cause a mild burning or stinging sensation.

You’ll likely feel some pressure when your doctor inserts the needle into the epidural space to inject the steroid medication. If you do feel any pain, your doctor can give you more of the local anesthesia to relieve it.

The epidural injection should start to relieve your back pain within 1 to 3 days. But sometimes it can take up to a week to see an improvement.

This treatment isn’t a cure for back pain, although some people do get permanent relief. Typically, if you’ve had chronic back pain, the injection may continue to work for 3 to 6 months or longer.

If the pain returns, you may need to get injections a few times a year. To potentially help extend the effects of this treatment, you may want to consider:

  • exercising regularly
  • not smoking
  • staying at a healthy weight for your body

Recovery from an epidural steroid injection is usually quick.

You won’t be able to drive for the rest of the day and will need someone to help you get home from the appointment.

Avoid soaking in a tub, pool, shower, or any other water until your doctor says you can resume these activities.

You should be able to go back to your usual activities the day after the procedure. But soreness might keep you from more strenuous activities, such as exercise, for a few days.

Your back might be a little sore for a few days after the injection. Holding an ice pack to the area three or four times per day and taking an over-the-counter pain reliever can help.

Epidural steroid injections are safe overall. The most common side effects are mild and may include:

  • pain at the injection site
  • redness of your face and chest, called a steroid flush
  • trouble sleeping
  • anxiety
  • hot flashes
  • an increase in blood sugar levels
  • fluid buildup
  • increased back pain
  • headache

These side effects should improve without treatment within 1 or 2 days.

More serious problems are rare but can include:

  • bleeding
  • allergic reaction
  • infection
  • nerve damage
  • numbness or tingling
  • paralysis

Let your doctor know if your back still hurts a few days after the injection. And call your doctor’s office right away if you have more serious side effects, such as bleeding or an allergic reaction. Call 911 or go to an emergency room if you need emergency care.

Before receiving an epidural steroid injection, discuss the benefits and risks of this treatment with your doctor.

Epidural steroid injections temporarily — and sometimes permanently — relieve back and leg pain from conditions such as a herniated disc or degenerative spine disease. Results can last for several months.

If you get a steroid injection and your pain doesn’t improve, talk with your doctor. The pain may not be coming from nerves in your spine.

You may need more tests to figure out the cause and a different type of treatment to relieve it.

What are the side effects of steroid injections for back pain

  • What are epidural steroid injections?
  • What are they used for?
  • Who can benefit from them?
  • How do the injections work?
  • How often can you get  injections?
  • How long do they last for back pain?

  • What are the risks?
  • Are there side effects?
  • How should I prepare for my procedure?
  • Is any anesthesia used? Is it painful?
  • Will I have to lie on my stomach for long?
  • Who performs they injections?

Epidural corticosteroid injections place medication directly around a pinched nerve as it exits the spine within the epidural space. The epidural space is between the bones and discs of the spine, and the nerves and spinal cord. This is the space into which disc tissue can herniate and cause pressure and inflammation around spinal nerves.

What are epidural corticosteroid injections used for?

Epidural steroid injections are commonly used to treat back pain caused by a herniated disc (slipped disc), lumbar radiculopathy, spinal stenosis or sciatica. Corticosteroids are strong anti-inflammatory medications and, when placed into the epidural space, can significantly reduce inflammation around an irritated nerve that is causing back and leg pain and discomfort.

Who can benefit from an epidural steroid injection?

Patients with several common conditions – including lumbar disc herniation, degenerative disc disease, lumbar radiculopathy, sciatica, lumbar spinal stenosis, postherpetic neuralgia and facet/synovial cysts – may benefit from an epidural injection. An epidural steroid injection may be an effective nonsurgical treatment in itself or may aid in surgical planning.

How do epidural corticosteroid injections work?

Epidural steroid injections work by delivering a potent anti-inflammatory to the site of nerve impingement in the spine. Injected medications may include steroids, local anesthetics, and saline, and they can vary in volume and concentration on an individual basis.

Three routes may be used for epidural injections in the lumbosacral spine:

  • caudal
  • interlaminar (also known as translaminar)
  • transforaminal

Your physician will choose which method is right for you based on your diagnosis and if you have had any prior spine surgeries.

  • A caudal injection is the least complicated way to access the epidural space but is also the least specific. It can be useful if multiple areas of the spine are involved or if post-surgical changes prevent other approaches.
  • An interlaminar (or translaminar) injection delivers the medication directly into the epidural space at the affected level, can be targeted to one side or the other, and can treat multiple levels at once.
  • A transforaminal injection delivers the medication to the area where the specific affected nerve root exits the spine and is compressed by a disc herniation. It is the usual first choice approach for an epidural injection.

How often can you get epidural steroid injections?

Epidural steroid injections are recommended to be administered up to three to six times per year. In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common.

How long do epidural injections last for back pain?

Epidural steroid injections can help resolve pain permanently in patients with a new disc herniation who respond favorably. For patients with chronic pain or recurrent disc herniations, the desired duration of effect is three to six months or more.

What are the risks of epidural steroid injections?

The risks in any procedure involving a needle include bleeding, infection and nerve damage. When performed properly, the risk of any of these is exceedingly low and usually outweighed by the potential benefit of the procedure.

Some contraindications for performing epidural steroid injections include:

  • bleeding disorders or anticoagulation
  • medication allergies (rare)
  • systemic infection or localized infection overlying the area

What are the side effects of epidural steroid injections?

Common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, or increased blood sugar. These are usually self-limited and resolve within one to three days. A less common side effect is headache.

Is any preparation required? Can I eat before and after my epidural steroid injection?

Your doctor will give you specific instructions and these will vary by facility and type of epidural (lumbar, thoracic or cervical). Because the procedure is usually performed with local anesthetic, fasting guidelines are not overly prohibitive.

Is any anesthesia used? Are epidural steroid injections painful?

A local anesthetic is injected into the skin, numbing the area where the epidural needle is then placed. Patients may experience mild discomfort but should not experience severe pain during the procedure.

Will I have to lie flat on my stomach for long during or after the procedure?

The procedure can last anywhere from 10 to 20 minutes and requires the patient to lie prone, if possible, to allow for X-ray guidance (fluoroscopy). After the procedure, you can sit, stand, and walk as usual after a short period of monitoring.

Who performs epidural steroid injections?

Epidural steroid injections at HSS are performed by several types of doctors – pain management physicians, physiatrists and interventional radiologists – all of whom are trained to safely perform this procedure, often with additional subspecialty fellowship training.

Updated: 9/15/2020

Authors

What are the side effects of steroid injections for back pain

Anuj Malhotra, MD
Director, Ambulatory Pain Medicine Program, Hospital for Special Surgery
Assistant Attending Physician, Pain Management, Hospital for Special Surgery

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Can steroid injections make your back worse?

After the shots, your pain may get worse before it gets better. Serious side effects from an epidural steroid injection are rare.

What is the next step if steroid injection does not work?

When one (or several) injections fail to fix your problem, often the next recommended step is surgery. The majority of the people we work with are seeking pain relief for their back, knee, neck or shoulder WITHOUT the need for surgery and other procedures.

How safe are steroid injections in the back?

Epidural steroid injections have been used for years and are considered one of the safest options for pain management in the lower back. However, as with all minimally invasive procedures, there are small but extremely rare risks involved.

How long should you rest after a steroid injection?

It helps to rest the joint for 24 hours after the injection and avoid heavy exercise. It's safe to take everyday painkillers such as paracetamol or ibuprofen.