Do Epidural Steroid Injections Really Work — Or Do They Just Mask the Pain?

“Isn’t this just going to mask my pain?” I hear some version of that question in almost every consult, and it usually comes down to one thing patients really want to know: do epidural steroid injections really work, or are they just buying a few hours of relief? It’s such a common question that I wanted to set the record straight.

So let’s walk through what an epidural steroid injection actually does, what you can realistically expect, and how I decide whether it’s the right next step for a patient.

What happens during a spine injection?

If you’re picturing something scary or painful, you can relax. The appointment is more low-key than most people expect. I clean the skin on your back, use a fluoroscopy machine (a specialized, low-dose x-ray) to guide a small needle to the spot next to the irritated nerve root, confirm placement with a contrast dye, and then inject a small amount of numbing medicine (lidocaine) with steroid medication.

I use a small needle to keep discomfort to a minimum. Most patients feel some pressure and occasionally a brief pinch, but significant pain during the injection is uncommon.

Do epidural steroid injections work?

Here’s the part I want every patient to understand: the steroid is doing real work. When a disc herniation or arthritis crowds a nerve root, that nerve becomes inflamed — inflammation is what sends the pain signal, the ache, burn, or tingling running down your arm or leg, up to your brain.

The steroid I inject is a potent anti-inflammatory. Placed right next to that irritated nerve, it calms the inflammation down, and less inflammation means fewer pain signals. That’s not a mask — that’s addressing the source of the signal.

A 2020 comprehensive systematic review of lumbar transforaminal steroid injections for radicular pain found that 74% of patients with disc herniations achieved 50% or greater pain-reduction at three months. View the study.

While the injection calms the inflammation and pain, it doesn’t reverse the cause of the problem such as a herniated disc or arthritic joint. But calming inflammation often buys the body time and comfort to heal, and it can make a real difference in whether you’re able to participate in physical therapy and get back to daily life.

When will I start feeling better after a steroid injection in my spine?

Patients are often surprised that relief doesn’t work quite the way they expect. The numbing medicine works fast, so you may walk out of the procedure room already feeling better, but that effect fades within a couple of hours. The steroid itself takes a bit longer to kick in, typically a couple of days, and for some patients up to a week to reach its maximum effect.

Feeling great immediately and then a little sore later that same day is normal — that’s the lidocaine wearing off before the steroid has kicked in.

How long does the pain relief from a spinal injection last?

The length of time a spinal injection helps with pain varies from person to person because it depends largely on what is causing the nerve irritation in the first place. For some patients, relief may last a couple of weeks. For others, it can last months or even much longer.

For example, many disc herniations naturally shrink or resorb over time as the inflammation settles down. In those cases, an injection may reduce the inflammation and pain enough to allow the underlying problem to improve, so the relief can be quite long-lasting.

With spinal stenosis, the response is more unpredictable. If inflammation around a compressed nerve is contributing to the symptoms, an injection may provide meaningful relief for a period of time. However, if symptoms are primarily due to fixed narrowing and mechanical compression, an injection may provide limited or temporary benefit.

The goal isn’t necessarily to make the pain disappear forever with one injection, but to reduce pain enough to help you stay active, participate in therapy, and give the underlying condition a chance to improve.

Am I a good candidate for epidural steroid injection?

Patients who benefit most from an injection are those who have pain radiating down an arm or leg, caused by a pinched nerve in the neck or back. We use epidural steroid injections less often in patients whose pain is primarily isolated to the back or neck.

Patients who typically aren’t good candidates include those with:

• Uncontrolled diabetes
• An active infection
• Other medical reasons that make the procedure unsafe

Are spinal injections safe and how many can I get?

Epidural steroid injections are generally very safe, though like any procedure, there are some very small risks. Common, minor risks include discomfort during the procedure and bruising or soreness afterward. Rare risks include bleeding, infection or nerve injury.

I typically limit injections to no more than four per year, even when they’re working well, because repeated steroid use can affect bone density and temporarily raise blood sugar and blood pressure.

There’s No One-Size-Fits-All Answer

You may have read that epidural steroid injections just mask pain and shouldn’t be used. That really stems from a misinterpretation of the fact that it calms inflammation but doesn’t “fix” the structural problem. Calming inflammation, which decreases pain signals, is not masking the pain — it’s actually stopping the pain.

When I sit down with an individual patient, I’m asking whether calming this specific nerve’s inflammation will give enough relief to do physical therapy and let the body heal. For the right patient, in the right situation, the answer is often yes. I don’t recommend this procedure unless I genuinely expect it to help.

Frequently Asked Questions

Do epidural steroid injections for spine pain work for everyone?

No, and I wouldn’t want to promise that. They tend to work best for nerve pain radiating down an arm or leg. For pain that stays only in the back or neck, or for certain underlying causes like significant spinal stenosis, relief is less predictable.

Will the injection hurt?

Most patients feel some pressure and occasionally a brief pinch, but significant pain is uncommon. I use a small needle to help keep it that way.

Does it fix the underlying problem?

Not directly — it calms inflammation around the nerve, which is usually causing the pain. That relief often gives your body the window it needs to heal, and it makes it easier to participate in activities and physical therapy.

How many injections can I get in a year?

Up to four, as long as they’re providing relief. We limit the number to reduce potential side effects.

Does research support epidural steroid injections to help relieve pain stemming from the spine?

A 2020 comprehensive systematic review of lumbar transforaminal steroid injections for radicular pain found that 74% of patients with disc herniations achieved 50% or greater pain-reduction at three months. View the study.

Interested in learning whether an epidural steroid injection or other non-surgical pain management procedures can help relieve your pain? Request an appointment with Dr Woodworth in the Neurosurgery One clinics in Parker and Lone Tree.