Spinal Epidural Steroid Injection

How Effective is it for Back Pain?

Spinal epidural injection is one of the most common treatments for managing certain types of chronic back pain.

An epidural steroid injection is a shot of anti-inflammatory steroid medication delivered to the area between the vertebrae and the outer covering of the spinal cord. This area is known as the epidural space.

Epidurals necessarily involve needles. In order to guide the needle to the exact location where the medication is to be delivered, the doctor uses fluoroscopy, which is a system that takes x-ray images of the area and projects them onto a monitor.

Spinal Epidural - When is it Appropriate?

Epidurals are usually tried after conservative, non-invasive treatments have not proven successful, but just before back surgery becomes a possibility. They are also given to those people for whom surgery is the right choice, but for whatever reason it is not a practical or feasible solution. On the whole, though, research shows that when it comes to relieving pain, spinal epidurals are not a successful replacement for back surgery.

Spinal epidural injections are rarely recommended for back problems other than sciatica or radiating pain due to a herniated disc, as little research supports their use. (Radiating pain is pain down an arm or leg.) Laxmaiah Manchikanti, M.D., pain researcher and chairman of the Board of the American Society of Interventional Pain Physicians says it is possible that spinal epidurals may occasionally have some value for cases of degenerative disc disease, spinal stenosis or failed back surgery syndrome that results from a laminectomy.

But research that Dr. Manchikanti published in 2008 indicates pain due to a facet joint requires an injection specific to that joint. "There is no role for epidural injections in managing facet joint problems," Dr. Manchikanti told About.com.

How Well Might a Spinal Epidural Relieve Your Back Pain?

But even for radiating pain, the effect of an epidural injection is limited.

Pain reduction lasts for about 3 to 4 weeks for your first one, 6 to 8 weeks for your second and up to 3 months for your third one. The first two injections in a series are considered to be diagnostic and all the others are seen as treatments for pain.

If your epidural is given for radiating low back pain, your doctor may begin by injecting your L4-5 and/or your L5-S1 areas, as this is usually where disc-related back and leg pain originates. She might also use her knowledge of dermatomes and results from your diagnostic imaging tests to determine the best place to inject the medication. The whole procedure takes about a half hour, and you will need 45 more minutes for recovery time. If the pain persists after the injection, you may be advised to get a discogram, which will enable the doctor to more specifically identify which, if any, discs are the cause.

According to Dr. Manchikanti, about 40% of spinal epidurals fail to relieve the pain, even when an epidural is the appropriate treatment for the patient and when the procedure is done right.

Most of the time, this is because the injected medication does not get to its destination (the epidural space). This may be due to the inadequacy of the technique the doctor uses for the particular problem you may be having, or it may be because the type of epidural the doctor chose to use is not effective for reaching the pain site. (Types of epidurals are based on where in the spine the needle is placed.)

Spinal Epidural - Buyer Beware

Where you live may have a lot to do with whether or not an epidural will be given to you for your back pain. For example, a geographical analysis showed that more spinal epidural treatments are given in southern states, with Alabama leading the pack, than anywhere else. (Northeastern states have the lowest spinal epidural injection rates.)


Email Interview. Laxmaiah Manchikanti, MD Chief Executive Officer and Chairman of the Board, ASIPP and SIPMS and Medical Director, Pain Management Center of Paducah, KY. April 23 2009.

Friedly J, Chan L, Deyo R. Geographic variation in epidural steroid injection use in medicare patients. J Bone Joint Surg Am. 2008 Aug.

Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Jul. 84 p. [171 references]

Binder, A. Diagnosis and treatment of non specific neck pain and whiplash. Eura Medicophys 2007.

Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009 Jan-Feb.

Harrast, M. Epidural steroid injections for lumbar spinal stenosis. Curr Rev Musculoskelet 2008.

Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Lumbar facet joint nerve blocks in managing chronic facet joint pain: One-year follow-up of a randomized, double-blind controlled trial: Clinical Trial NCT00355914. Pain Physician 2008.

Carol A. Warfield, Zahid H. Bajwa Principles and Practice of Pain Medicine. 2nd ed. McGraw-Hill Professional, 2004. Accessed online

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