Epidural steroid injections are a popular minimally invasive treatment for back pain. But if you’re considering an epidural injection, you might be surprised to learn that they don’t always work on the first try — and you might be left wondering if it’s a good choice for you.
Understanding how epidural injections work, when they’re most effective, and what to do if you don’t get immediate relief can help you set realistic expectations. Eric Fanaee, MD, specializes in pain management, and he’s dedicated to helping you find pain relief that really works. Here’s what you need to know.
An epidural steroid injection delivers a mixture of corticosteroid and local anesthetic into the epidural space of your spine, which is the area just outside the protective covering of your spinal cord. The treatment targets inflamed nerve roots directly to interrupt pain signals and reduce swelling.
Dr. Fanaee and our team use image guidance — either fluoroscopy or ultrasound — to pinpoint the exact source of your pain and precisely place the medication. The method increases your chances of successful pain relief, but it’s important to note that epidurals don’t work for every type of chronic back pain.
We typically recommend epidural injections for conditions like sciatica, where a herniated disc or spinal stenosis compresses a nerve root. The treatment tends to be less effective for pain without nerve involvement, and we may prescribe conservative care — such as NSAIDs or physical therapy — before trying epidural injection.
The level of pain relief that epidural injections deliver varies from person to person, but it’s possible to experience significant short-term relief and improved function.
For example, studies show that 40%–80% of people with lumbar disc herniation and sciatica experience at least 50% pain relief lasting from three months to a year after one to four injections. In cases of foraminal spinal stenosis, about 87% of patients with mild to moderate stenosis achieve significant pain relief for roughly three months.
There are a few reasons why an epidural injection might not provide immediate relief. First and foremost, accurate needle placement is essential. Off-target placement can dramatically reduce efficacy, which is why using image guidance is so important.
People with long-standing, chronic pain often respond less well to epidurals compared to people with newer pain. And if a patient’s pain isn’t caused by nerve root irritation, the injection may not be effective at all.
Other factors, such as the route of administration (transforaminal versus interlaminar) and the type of steroid used, can also influence outcomes.
It can take 7-10 days to feel the full effect of an epidural injection, and even then, pain relief might be minimal. In these cases, we might recommend considering options like:
If your pain persists despite these efforts, it might be time to consider surgery for longer-lasting relief. Dr. Fanaee and our team have the expertise to tailor your pain management plan to your situation, and we’re here to help you navigate your options.
If your first epidural didn’t hit the mark, reach out — Dr. Fanaee can reassess your diagnosis, refine your treatment plan, and guide you toward lasting relief. Call us at 631-265-2020 or book online at one of our clinics in Copiague, Smithtown, and West Islip, New York.
