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Epidural injections for lower back and leg pain


Expert reviewer, Dr Dudley Bush, Consultant in Anaesthesia and Pain Management
Next review due August 2018

Epidural injections into your spine can sometimes provide short-term relief from pain in your lower back and legs, which is known as radicular pain.

If you’re considering having an epidural injection, it's important to make a decision that’s right for you. This information is designed to help you decide whether to have an epidural injection or not.

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What are epidural injections?

An epidural is an injection that contains a steroid dissolved in a local anaesthetic. It's injected into a gap called the epidural space, which surrounds your spinal cord. The local anaesthetic will block the pain temporarily, while the steroid will reduce swelling and inflammation.

The injections can be given at different points in your back. One in the base of your spine is called a caudal epidural whereas one in your lower back is called a lumbar epidural. Where you have an epidural injection will depend on what you're having it for.

Why would I have an epidural injection?

Epidural injections can treat pain in your lower back and legs, which is known as radicular pain. Your doctor will usually suggest you try other treatments before offering you an epidural injection. These alternatives may include exercise, physiotherapy and painkillers, for example.

It isn't known for sure how well epidural injections work for back and leg pain, as studies have come up with inconsistent results. However, there's some research to suggest they can sometimes help to manage pain in your back and legs, caused by conditions, such as:

  • a slipped disc (herniated disc) – this is when one of the discs in your spine bulges
  • sciatica – this is when a nerve in your spine becomes compressed or irritated
  • spinal stenosis – this occurs when the space around your spinal cord narrows, putting pressure on your spinal cord

You will usually have epidural injections as part of a wider treatment plan that includes other therapies such as exercises and rehabilitation. It’s important to realise that, like other treatments for these conditions, not everyone gets pain relief from an epidural injection. And if you do, it will only be temporary. However, if an epidural injection does help to relieve your pain, it may allow you to do physiotherapy or other rehabilitation. This may then improve your symptoms in the long term.

Exercises for low back pain by Bupa UK

Epidural injections aren't a suitable treatment for everybody. For example, if you have a bleeding disorder or certain allergies, you shouldn't have one. If your back is sore or stiff but your doctor can't find a particular cause for the pain, they won't offer you an epidural injection. It's unlikely to help. Ask your doctor if an epidural injection is an option for you.

Click on the image to open our infographic of exercises for low back pain.

What happens during an epidural injection?

You will usually have an epidural injection in hospital. You can have the injection and go home the same day – you won't need to stay overnight. A specialist doctor (sometimes an anaesthetist) will give you the epidural injection.

Your doctor may give you a local anaesthetic to numb any pain while you're having it done. They may offer you sedation too, to help you relax. Your doctor will need to take X-rays CT or ultrasound scans to help them guide the needle to the right spot. They may need to inject a type of dye called contrast media to help highlight where the needle needs to go.

You will need to lie on your tummy or your side while you have the procedure. It will only take a few minutes to give you the epidural injection but it may take longer to have imaging such as X-rays.

What to expect after receiving an epidural injection

After you have had an epidural injection, you will need to stay sitting or lying down for about 15 minutes. Your legs may feel numb or tingly at first because of the local anaesthetic, but this will go away. Don't drive yourself home – ask your family or a friend to go with you to hospital. Take it easy for the rest of the day when you get home.

Epidural injections don't work for everyone and even if it does work, it can take several days for you to feel the effect. Your pain may even get worse before it starts to get better from the epidural. It's a good idea to keep a pain diary as this can help your doctor to see whether or not the injection has worked for you.

Pros and cons

This information is intended to help you understand the advantages and disadvantages of having an epidural injection for lower back and leg pain. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that's right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

Pros

  • An epidural injection may reduce your pain for a short time. This can improve your quality of life and make it easier to get about and get on with your normal daily activities in the short term.
  • If the epidural injection helps to reduce your pain, you may find it easier to do physiotherapy or other rehabilitation. This may help to improve your back problem in the long term.

Cons

  • You might not get any pain relief from epidural injections.
  • The pain relief you may get from an epidural injection will probably last only between three months and a year. It isn't a cure for your pain.
  • There are possible risks and complications linked to epidural injections, which include headaches, bleeding, an infection, an allergic reaction and nerve damage. Although you're unlikely to get any of these, it’s important to be aware of them when deciding whether or not to have the injection.

Making your choice about epidural injections

Different things are important to different people. Have a think about how important each of the issues above is to you in making your decision whether to have epidural injection or not. Next, together with your doctor, do the following.

  • Review the list of pros and cons.
  • Rank each of them from zero to five, with five being the most important to you.
  • Add up the total value for the pros and cons – the highest total value should indicate what’s important to you.

Your doctor can give you advice and help you choose the right treatment for you.

Questions to ask your doctor

Have a think about any questions you would like to ask your doctor before you decide whether to have an epidural spinal injection or not. Here are some example questions you might like to ask.

  • What else can I do to help relieve my pain?
  • Should I try other treatments first before having an epidural?
  • What should I expect to happen after I’ve had my epidural injection?
  • Will I be able to exercise after the injection? Are there any types of exercise that it's best not to do?
  • Should I have physiotherapy or other some rehabilitation after having my epidural injection?
  • How can I tell if my epidural injection has worked?


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Related information

    • Spinal stenosis. BMJ Best Practice. www.bestpractice.bmj.com, published 9 October 2014
    • Low back pain and sciatica. Medscape. www.emedicine.medscape.com, published 22 December 2014
    • Epidural injections. Radiological Society of North America. www.radiologyinfo.org, published 14 August 2013
    • Musculoskeletal lower back pain. BMJ Best Practice. www.bestpractice.bmj.com, published 3 October 2014
    • Discogenic low back pain. BMJ Best Practice. www.bestpractice.bmj.com, published 19 November 2014
    • Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. University of York Centre for Reviews and Dissemination. www.crd.york.ac.uk, published 16 November 2012
    • Adult acute and subacute low back pain. Institute for Clinical Systems Improvement. www.icsi.org, published November 2012
    • Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Care Excellence (NICE), May 2009. www.nice.org.uk
    • Recommendations for good practice in the use of epidural injection for the management of pain of spinal origin in adults. Royal College of Anaesthetists. www.rcoa.ac.uk, published April 2011
    • Epidurals and back pain. Back Care. www.backcare.org.uk, published March 2010
    • Epidural steroid injections. Medscape. www.emedicine.medscape.com, published 9 July 2015
    • Pain and pain relief. PatientPlus. www.patient.info/patientplus, reviewed 16 January 2015
    • Risks associated with your anaesthetic. Section 11: nerve damage associated with a spinal or epidural injection. Royal College of Anaesthetists. www.rcoa.ac.uk, published 2013

  • Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, August 2015
    Expert reviewer, Dr Dudley Bush, Consultant in Anaesthesia and Pain Management
    Next review due August 2018



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