Epidural injections for lower back and leg pain
Your health expert: Dr Johann Emmanuel, Consultant in Pain Medicine
Content editor review by Pippa Coulter, March 2021
Next review due March 2024
Epidural steroid injections can help relieve pain in your back or legs caused by sciatica. It involves a minor procedure in hospital to have an injection in your back.
What are epidural injections?
An epidural injection contains a steroid medicine, usually together with a local anaesthetic. These injections are also called epidural steroid injections. The liquid is injected into a gap called the epidural space, which surrounds your spinal cord. The steroid reduces inflammation around your spinal cord, while the local anaesthetic provides faster pain relief.
The injections can be given at different points along your back. An injection in your lower back is called a lumbar epidural. There are different techniques for giving epidural injections for lower back and leg pain:
- interlaminar – this is given between two of your vertebrae (back bones)
- transforaminal – this is an injection into the side of your spine
- caudal – this is given through an opening at the base of your spine
Uses of epidural injections
Epidural injections can help with sciatica (radicular pain). This is pain that spreads from your lower back down your legs. It’s caused by a trapped nerve in your spine. There are several things that can cause this.
- A slipped disc (herniated disc). This is when one of the discs between your vertebrae (back bones) bulges out of your spine, sometimes pressing on surrounding nerves.
- Spinal stenosis. This is when the space around your spinal cord narrows, putting pressure on your spinal cord.
- Spondylolisthesis. This is when one of your vertebrae moves out of position.
You’ll need an assessment with a pain specialist or spinal surgeon to have an epidural injection for sciatica. Your GP may refer you if you have severe sciatica or sciatica that’s not improving with other treatments like exercise programmes and painkillers. You may also be able to book an appointment yourself with a private consultant in pain medicine (you’ll need to pay for this).
Epidural injections aren't a suitable treatment for everybody. The specialist doctor will tell you if they’re an option for you. If you’re on blood-thinning medication or have an infection or could be pregnant, let your doctor know. They may need to make extra preparations or postpone your injection. Also tell your doctor if you’ve had an allergic reaction to previous injections or if you have a bleeding disorder.
Alternatives to epidural spinal injections
Your doctor will discuss your treatment options to help you decide whether or not to have an epidural for your lower back or leg pain. Most episodes of sciatica get better on their own in time, without the need for injections or other invasive treatments. There are many other methods for managing the pain, including painkillers and physiotherapy. You might decide to try or continue using these options rather than have an epidural injection.
Deciding on epidural injections
If your doctor offers you an epidural injection, they’ll discuss with you exactly what to expect, including all the potential benefits and risks. Be sure to ask your doctor if you have any questions or need any more explanation. You'll need to give your consent if you do choose to have the injection, so it’s important that you feel fully informed.
Here are some of the key pros and cons (benefits and risks) you may wish to consider.
Pros
- An epidural injection may relieve your pain, sometimes for up to several months at a time. This can make you feel better and make it easier to get on with your normal daily activities in the short term.
- If the epidural injection does help to reduce your pain, you may find it easier to do physiotherapy or other rehabilitation. This may help to improve your pain in the long term and prevent it coming back.
- If the injection is successful, it may reduce the need for more invasive procedures, including surgery.
Cons
- You’ll need a minor procedure in hospital to have the injection, and it might not give you any pain relief.
- Any pain relief you do get from an epidural injection may be short lived and is unlikely to last more than a year. It isn't a cure for your pain.
- Although rare, it's possible to have a serious complication from an epidural injection. This includes infection, bleeding or nerve damage.
Preparing for an epidural injection
Your doctor will explain how to prepare for your procedure. You'll need to go into hospital to have an epidural injection from a pain specialist or spinal surgeon. You'll usually have the injection and go home later the same day. Make sure that you arrange for someone to drive you home, and preferably stay with you overnight.
You may be asked to stop eating and drinking for several hours before having an epidural injection. You’ll usually still be allowed to have clear fluids up to a couple of hours beforehand. Follow any instructions given to you by your doctor.
Tell your doctor about any medications you’re on. If you’re taking any medicines, particularly blood thinning medicines, you may be asked to stop taking these for a few days before the procedure. Never stop any medication unless your doctor tells you to.
What happens during an epidural injection?
At the hospital, your doctor will check that you’re well and still happy to go ahead with the procedure. You may be asked to change into a gown. When they’re ready to start, your doctor will ask you to lie down on a special table. They may position you on either your front or your side.
Your doctor will usually place a cannula (fine tube) in the back of your hand before carrying out the injection. This is in case you need any medication during the procedure. They’ll then carefully clean and prepare the area on your back where you're having the injection, using an antiseptic solution. Your doctor will inject a local anaesthetic to numb the area. This may sting a little.
Your doctor will guide the epidural needle to the right area in your back using real-time X-ray images (fluoroscopy). They’ll usually inject a type of dye, called contrast, to check when the needle is in the right position. Once the needle is in position, your doctor will slowly inject the medication into the epidural space surrounding your spinal cord. You might feel some pressure when you have the injection, but it shouldn’t be painful. Let your doctor know if you do feel any discomfort though.
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. It might take around 30 minutes to complete the procedure.
How an epidural is given
What is an epidural? | the procedure - watch in 1 minute 37 seconds
An epidural is an injection into your lower back to temporarily block pain from your waist down. This video describes how an epidural is given.
Aftercare for epidural injection
Your doctor or nurses will take you to a recovery room after the procedure. The nursing staff will monitor you for a short time before you're able to leave. Sometimes, they’ll ask you to lie flat for around 30 minutes or so. They may check your blood pressure or pulse, and ask if you're experiencing any side-effects. The nursing staff looking after you will make sure that you can stand up when you feel ready.
You'll usually be able to go home within a few hours after your injection, and sometimes much sooner. But you’ll need somebody to drive you home – you won't be able to drive yourself. Ideally, you should also have someone stay with you for your first night at home after your procedure.
It can take several days to feel any effects from the injection. In fact, some people find that their pain gets worse at first. This should settle down within a few days. Try to keep as active as you can, and as your pain improves, you can gradually increase how much you do.
Do epidural injections work well for back and leg pain?
There's good evidence that epidural injections can help many people with back and leg pain. But it’s important to realise that it doesn’t work for everyone. How likely it is to work for you depends on many factors. For instance, you're more likely to benefit if your pain is due to a slipped disc, rather than spinal stenosis. And the injection is more likely to work if you haven't had symptoms for very long. The success rate will also vary between doctors and depend on the technique they use. Ask your doctor how these factors apply to you.
If you do get pain relief from an epidural injection, it tends to be short lived (days or weeks). Some people do find that it works for longer – up to several months or more. The amount of pain relief you get and how long it lasts varies from person to person. If you’ve found it helpful, your doctor may recommend you have repeat injections (usually up to three or four) until the pain has gone.
If an epidural injection does help to relieve your pain, you may find it easier to keep active or take part in other treatments, such as physiotherapy. This is important because keeping active is likely to improve your pain in the long run – and also means it’s less likely to come back.
Side-effects of epidural injections
Side-effects are unwanted but mostly temporary effects that you may get from having the procedure. The main side-effect associated with epidural injections is mild discomfort in the area where you have the injection. This usually gets better on its own within a few days.
Some people have a reaction to the medicines used in the injection. For instance, you may have skin reactions, such as flushing or a rash. You may also have a short-term increased risk of infections. If you are a woman, you may have changes to your menstrual cycle. Some people feel sick or dizzy, and may faint.
It's possible for the local anaesthetic from the injection to spread, causing temporary numbness or weakness in your legs. This should get better very quickly.
Complications of epidural injections
Complications are unexpected problems that can happen during or after the treatment.
More serious complications from epidural injections are rare, but it's important to be aware of them. They include the following.
- Infection, which can spread to your spine. You're at greater risk if you have diabetes or if you have a weakened immune system. If the injection site becomes warm or red and you feel hot and unwell, contact the unit where you had the injection. It can be treated with antibiotics.
- A dural puncture. This is when the needle has gone too far and entered the spinal fluid. You may develop a severe headache as a result and need to stay in hospital for longer. It happens in fewer than one in 100 people. If you develop a headache after you've got home, take some paracetamol and lie flat. Contact the unit if it carries on for longer than 24 hours.
- Bleeding into the epidural space (a haematoma). This is rare (affects between 1 and 2 in 10,000 people), but it can be serious. If it did happen, you would need surgery to deal with it.
- Injury to a nerve. This can cause weakness of your legs and incontinence. It's usually temporary and means you’ll need to stay in hospital to be monitored. Serious injury is very rare (affects fewer than 1 in 10,000 people).
Your doctor will have measures in place aimed at keeping the risk of these complications as low as possible.
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 other treatment options do I have to relieve my pain?
- What can 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? How long will it take until I know if it's worked?
- What is the likelihood of the procedure working? How long will the effects last?
- How will you reduce the risk of complications?
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Local anaesthesia
Local anaesthesia involves numbing a small part of your body with a medicine called a local anaesthetic
Corticosteroids
Lower back pain
Back pain is very common, with around one in three of us getting it every year. It’s usually the lower back that’s affected.
Physiotherapy for lower back pain
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