Epidural Steroid Injection: What It Is and What to Expect
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor provides Epidural Steroid Injection?
A pain medicine doctor (a doctor who treats long-lasting pain) or a spine doctor usually gives an epidural steroid injection. It is done in a hospital or outpatient clinic. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
Here, an epidural steroid injection means a shot for back pain. An epidural steroid injection, or ESI, puts strong anti-inflammatory medicine into the epidural space of your spine. Anti-inflammatory means it lowers swelling. The numbing medicine in the mix can also help find the painful nerve. An ESI is a different treatment from the epidural anesthesia used before childbirth or certain types of surgery. Steroid does not change the underlying condition, but it can break the cycle of pain and inflammation.
Why a doctor might recommend it
Your provider may suggest an ESI for pain that spreads from the lower spine into the hips or down the leg. Two causes of chronic back pain that doctors have studied with these shots are radiculopathy and spinal stenosis. Radiculopathy is a pinched nerve in your spine. Spinal stenosis means the space around your spinal cord or nerves has become too small. An ESI is used only when medicines, physical therapy, or other nonsurgical treatments have not eased your pain.
How to prepare
- You will most likely get an x-ray, MRI, or CT scan of your back before the shot.
- Tell your provider about any illness you have before the shot.
- Tell your doctor if you have diabetes or an allergy to contrast dye.
- You may be asked to pause blood thinners for a short time.
- If you smoke, cut back or quit, because smoking can slow healing.
- Follow the instructions about when to stop eating and drinking.
What happens during it
You lie face down on an x-ray table. Your provider cleans your back, and numbing medicine may be used. Your provider guides the needle with an x-ray machine that shows real-time images. A mix of steroid and numbing medicine is then injected. Most of the time, the procedure is not painful, though you may feel some pressure.
Recovery
You are watched for 15 to 20 minutes after the injection before going home. Your pain may become worse for 2 to 3 days before it begins to improve. The steroid usually takes 3 to 5 days to work.
An ESI gives short-term pain relief in at least half of the people who receive it. Symptoms may stay better for weeks to months, but rarely up to a year. The American Academy of Neurology says the shots have limited effectiveness in the short term for some forms of chronic back pain. In its review, they may modestly reduce pain for up to three months in people with a pinched nerve, but they were not found to reduce pain at three months in people with spinal stenosis.
Risks and side effects
An ESI is generally safe. Serious problems are rare, but they could include allergic reaction, bleeding, infection, nerve damage, or paralysis.
- Mild dizziness, headache, or an upset stomach.
- A spinal infection, such as meningitis or an abscess.
- Bleeding around the spinal column, called a hematoma.
- Trouble breathing if the injection is in your neck.
- A flushed face and chest, anxiety, trouble sleeping, or a change in your period, which are usually mild.
Too many shots, or higher steroid doses, may weaken the bones of your spine or nearby muscles.
Call 911 or go to the emergency room if you have trouble breathing, fainting, or bleeding that will not stop. Also call if you have chest pain or discomfort lasting two minutes or more, sudden weakness, or a change in mental status such as confusion.
Who performs it
A provider does the injection using x-ray guidance. The risk of a serious problem is minimized when an experienced doctor does the injection.
Common questions
Does an epidural steroid injection cure back pain?
No, an epidural steroid injection does not cure the cause of your back pain. You will need to keep up back exercises and other treatments.
Is an epidural steroid injection painful?
Most of the time, the procedure is not painful. You may feel some pressure during the injection.
How does a direct primary care or concierge doctor fit in?
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
Sources
- MedlinePlus - Epidural injections for back pain
- American Academy of Neurology - Epidural steroid injections for chronic back pain: An AAN systematic review
- North American Spine Society - Epidural Steroid Injections
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
