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Low Back Pain: Should I Try Epidural Steroid Shots?

Low Back Pain: Should I Try Epidural Steroid Shots?

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Low Back Pain: Should I Try Epidural Steroid Shots?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Try Epidural Steroid Shots?

Get the facts

Your options

  • Try epidural steroid shots for low back pain.
  • Don't try epidural steroid shots. Try medicines, physical therapy, and home treatment instead.

Key points to remember

  • Epidural corticosteroid shots (injections) may give you short-term relief from back pain that runs down your leg. On average, pain relief from the shots lasts about 3 months. footnote 1 But that may be enough time for your back to heal so your pain doesn't come back.
  • The shots probably won't help at all if you have general back pain or pain that does not spread down your leg. footnote 2
  • Getting the shots may allow you to delay surgery, by reducing inflammation and relieving symptoms.
  • The shots may not improve your ability to do routine activities over the long term.
  • The most common side effect is a severe headache that lasts a few days. After the shots, your pain may get worse before it gets better.
  • Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.
FAQs

What are epidural steroid shots?

If you've had back pain for more than 6 weeks and your pain is very bad, your doctor might recommend a shot (injection) of corticosteroid, or steroid medicine, into your spinal canal. This is called an epidural injection.

Steroid medicines reduce inflammation and swelling. This can relieve pressure on nerves and nerve roots. The medicine can't fix your back, but it may give you short-term relief from back and leg pain.

The medicine may be given as 1 shot or a series of up to 3 shots about a month apart. More than 3 shots in the same spot within 12 months isn't recommended. footnote 3

How well do they work?

For some people, the shots provide short-term relief from pain, especially pain that runs down the leg. But relief doesn't last very long. In most cases, the shots only last about 3 months. footnote 1 But that may be enough time for your back to heal so that pain doesn't return.

The shots may allow you to postpone or avoid surgery. But they may not improve how well you can do your daily activities over the long term.

If you don't have pain that spreads from your back down your leg, it's unlikely that epidural steroid shots will help at all. Epidural steroid shots are not recommended if you have general, or nonspecific, low back pain. footnote 2

What are the risks of epidural steroid shots?

The most common problem is a severe headache that lasts for a few days. And your pain might get worse before it gets better.

Complications include infections or bleeding at the site of the injection.

Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.

What other treatments can help?

You may be able to relieve your symptoms by making lifestyle changes or trying other treatments, such as:

  • Exercise. Aerobic exercise —especially riding a stationary bike—can help your symptoms.
  • Medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen seem to be the most effective over-the-counter pain relievers for low back pain. If you can't take NSAIDs, you can try acetaminophen. Be safe with medicines. Read and follow all instructions on the label.
  • Healthy body weight. Getting to and staying at a healthy body weight may help your symptoms and keep the pain from getting worse.
  • Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms.
  • Cognitive-behavioral therapy for controlling pain and pain triggers. See a psychologist, a licensed counselor, or a clinical social worker who specializes in pain management skills.

Why might your doctor recommend epidural steroid shots?

Your doctor may recommend the shots if you've already tried other treatments for at least 6 weeks, and if you have pain that spreads down your leg.

Compare your options

Compare

What is usually involved?

















What are the benefits?

















What are the risks and side effects?

















Try epidural steroid shots Try epidural steroid shots
  • You'll be awake during the procedure.
  • You will be given medicine to numb the area where the needle is inserted.
  • You will be able to go home after the procedure.
  • If you have back pain that spreads down your leg, the shots may provide short-term pain relief. But that may be enough time for your back to heal so that pain doesn't return.
  • The shots may delay or avoid surgery.
  • The medicine won't fix your back.
  • Your pain might get worse before it gets better.
  • The most common side effect is a headache that lasts a few days. Other side effects, such as fever, pain, or infection, can occur.
  • Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.
  • If you don't have back pain that spreads down your leg, the shots probably won't help at all.
Don't try epidural steroid shots Don't try epidural steroid shots
  • You try other treatments such as medicines, exercise, and physical therapy to manage pain and help your back heal.
  • Your pain might go away after you try other treatments.
  • You avoid the cost of epidural steroid shots.
  • You avoid the risks of epidural steroid shots.
  • There are no risks to trying exercises and physical therapy.
  • Some medicines you take for pain may have side effects.

Personal stories about considering epidural steroid shots

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I started feeling better soon after I had the shot. I was able to sleep through the night without waking up from pain. It really helped my energy level. And I started taking short walks in the morning again.

Jane, age 39

I have a really hard time in general recovering from procedures. I guess I'm just sensitive or something. Anyway, I'm concerned that the shots may involve more pain than they're worth. I'm going to see if my back pain gets better on its own before I decide to have these shots.

Rick, age 70

I've had terrible back pain for a month or more, and now it's spreading down my leg. I tried taking it easy, but that isn't helping. I've thought about getting the steroid shots. But I don't want to pay for something that might not last very long. My doctor said losing some weight and trying physical therapy could help my back pain. I think I'll try those things first.

Carlos, age 42

I work in a retail store, and I'm on my feet all day. I have a hard time getting through the day, because my back and leg pain is so bad. I think the shots could help me, and I'm willing to try anything. I need to be able to do my job, and any pain relief would be a welcome thing.

Connie, age 58

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have epidural steroid shots

Reasons not to have epidural steroid shots

I don't care if the shots don't last. I want to try anything that might relieve my pain.

I don't want to try treatment that might not work or that won't last.

More important
Equally important
More important

I'm worried about the serious side effects, like paralysis, even though they're rare.

I'm not worried about the side effects.

More important
Equally important
More important

I've already tried other treatments.

I haven't tried other treatments.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting epidural steroid shots

NOT getting epidural steroid shots

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Can epidural steroid shots help with general back pain?
2, Can the shots provide short-term relief from back pain that spreads down the leg?
3, Can having the shots delay surgery?

Decide what's next

1, Do you understand the options available to you?
2, Are you clear about which benefits and side effects matter most to you?
3, Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

What matters to you  

Print Summary

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer William H. Blahd Jr. MD, FACEP - Emergency Medicine
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Jeffrey N. Katz MD, MPH - Rheumatology
References
Citations
  1. Armon C, et al. (2007). Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 68(10): 723–729.
  2. Dixit R, et al. (2013). Low back pain. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 1, pp. 665–682. Philadelphia: Saunders.
  3. Arden NK, et al. (2005). A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: The WEST study. Rheumatology, 44(11): 1399–1406.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Try Epidural Steroid Shots?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Try epidural steroid shots for low back pain.
  • Don't try epidural steroid shots. Try medicines, physical therapy, and home treatment instead.

Key points to remember

  • Epidural corticosteroid shots (injections) may give you short-term relief from back pain that runs down your leg. On average, pain relief from the shots lasts about 3 months. 1 But that may be enough time for your back to heal so your pain doesn't come back.
  • The shots probably won't help at all if you have general back pain or pain that does not spread down your leg. 2
  • Getting the shots may allow you to delay surgery, by reducing inflammation and relieving symptoms.
  • The shots may not improve your ability to do routine activities over the long term.
  • The most common side effect is a severe headache that lasts a few days. After the shots, your pain may get worse before it gets better.
  • Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.
FAQs

What are epidural steroid shots?

If you've had back pain for more than 6 weeks and your pain is very bad, your doctor might recommend a shot (injection) of corticosteroid, or steroid medicine, into your spinal canal. This is called an epidural injection.

Steroid medicines reduce inflammation and swelling. This can relieve pressure on nerves and nerve roots. The medicine can't fix your back, but it may give you short-term relief from back and leg pain.

The medicine may be given as 1 shot or a series of up to 3 shots about a month apart. More than 3 shots in the same spot within 12 months isn't recommended. 3

How well do they work?

For some people, the shots provide short-term relief from pain, especially pain that runs down the leg. But relief doesn't last very long. In most cases, the shots only last about 3 months. 1 But that may be enough time for your back to heal so that pain doesn't return.

The shots may allow you to postpone or avoid surgery. But they may not improve how well you can do your daily activities over the long term.

If you don't have pain that spreads from your back down your leg, it's unlikely that epidural steroid shots will help at all. Epidural steroid shots are not recommended if you have general, or nonspecific, low back pain. 2

What are the risks of epidural steroid shots?

The most common problem is a severe headache that lasts for a few days. And your pain might get worse before it gets better.

Complications include infections or bleeding at the site of the injection.

Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.

What other treatments can help?

You may be able to relieve your symptoms by making lifestyle changes or trying other treatments, such as:

  • Exercise. Aerobic exercise —especially riding a stationary bike—can help your symptoms.
  • Medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen seem to be the most effective over-the-counter pain relievers for low back pain. If you can't take NSAIDs, you can try acetaminophen. Be safe with medicines. Read and follow all instructions on the label.
  • Healthy body weight. Getting to and staying at a healthy body weight may help your symptoms and keep the pain from getting worse.
  • Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms.
  • Cognitive-behavioral therapy for controlling pain and pain triggers. See a psychologist, a licensed counselor, or a clinical social worker who specializes in pain management skills.

Why might your doctor recommend epidural steroid shots?

Your doctor may recommend the shots if you've already tried other treatments for at least 6 weeks, and if you have pain that spreads down your leg.

2. Compare your options

  Try epidural steroid shots Don't try epidural steroid shots
What is usually involved?
  • You'll be awake during the procedure.
  • You will be given medicine to numb the area where the needle is inserted.
  • You will be able to go home after the procedure.
  • You try other treatments such as medicines, exercise, and physical therapy to manage pain and help your back heal.
What are the benefits?
  • If you have back pain that spreads down your leg, the shots may provide short-term pain relief. But that may be enough time for your back to heal so that pain doesn't return.
  • The shots may delay or avoid surgery.
  • Your pain might go away after you try other treatments.
  • You avoid the cost of epidural steroid shots.
  • You avoid the risks of epidural steroid shots.
What are the risks and side effects?
  • The medicine won't fix your back.
  • Your pain might get worse before it gets better.
  • The most common side effect is a headache that lasts a few days. Other side effects, such as fever, pain, or infection, can occur.
  • Serious side effects from an epidural steroid injection are rare. But they can include stroke, paralysis, or loss of vision.
  • If you don't have back pain that spreads down your leg, the shots probably won't help at all.
  • There are no risks to trying exercises and physical therapy.
  • Some medicines you take for pain may have side effects.

Personal stories

Personal stories about considering epidural steroid shots

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I started feeling better soon after I had the shot. I was able to sleep through the night without waking up from pain. It really helped my energy level. And I started taking short walks in the morning again."

— Jane, age 39

"I have a really hard time in general recovering from procedures. I guess I'm just sensitive or something. Anyway, I'm concerned that the shots may involve more pain than they're worth. I'm going to see if my back pain gets better on its own before I decide to have these shots."

— Rick, age 70

"I've had terrible back pain for a month or more, and now it's spreading down my leg. I tried taking it easy, but that isn't helping. I've thought about getting the steroid shots. But I don't want to pay for something that might not last very long. My doctor said losing some weight and trying physical therapy could help my back pain. I think I'll try those things first."

— Carlos, age 42

"I work in a retail store, and I'm on my feet all day. I have a hard time getting through the day, because my back and leg pain is so bad. I think the shots could help me, and I'm willing to try anything. I need to be able to do my job, and any pain relief would be a welcome thing."

— Connie, age 58

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have epidural steroid shots

Reasons not to have epidural steroid shots

I don't care if the shots don't last. I want to try anything that might relieve my pain.

I don't want to try treatment that might not work or that won't last.

             
More important
Equally important
More important

I'm worried about the serious side effects, like paralysis, even though they're rare.

I'm not worried about the side effects.

             
More important
Equally important
More important

I've already tried other treatments.

I haven't tried other treatments.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting epidural steroid shots

NOT getting epidural steroid shots

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Can epidural steroid shots help with general back pain?

  • Yes
  • No
  • I'm not sure
That's right. The shots probably won't help at all if you have general back pain.

2. Can the shots provide short-term relief from back pain that spreads down the leg?

  • Yes
  • No
  • I'm not sure
You're right. The shots may relieve pain and swelling for a short time. On average, the shots wear off after about 3 months. But that may be enough time for your back to heal so that pain doesn't return.

3. Can having the shots delay surgery?

  • Yes
  • No
  • I'm not sure
You're right. The shots may delay surgery by reducing inflammation and relieving symptoms.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer William H. Blahd Jr. MD, FACEP - Emergency Medicine
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Jeffrey N. Katz MD, MPH - Rheumatology
References
Citations
  1. Armon C, et al. (2007). Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 68(10): 723–729.
  2. Dixit R, et al. (2013). Low back pain. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 1, pp. 665–682. Philadelphia: Saunders.
  3. Arden NK, et al. (2005). A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: The WEST study. Rheumatology, 44(11): 1399–1406.
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