Chronic back pain can touch almost every part of your day. Sitting on the train hurts, standing at kids' games is hard, and even simple things like food shopping or walking around the neighborhood can feel like a challenge. When pain drags on, it is easy to feel like you are losing control of your schedule, your mood, and your plans.
Epidural steroid injections are one option that may help. These are minimally invasive procedures that place targeted medication around irritated nerves in your spine. The goal is to calm inflammation, reduce nerve pain, and help you move with more comfort again.
In our pain management practice in Garden City, NY, we focus on non-surgical, interventional care for people with long-lasting back pain. In this article, we explain how epidural injections work, who may benefit, what to expect before and after the procedure, and how these injections fit into a bigger plan for long-term pain control.
How Epidural Injections Work for Chronic Back Pain
To understand epidural injections, it helps to know a bit about the spine. Your spinal cord runs through a bony canal in your back. Nerve roots branch off the cord and travel down into your hips and legs. Around the outer covering of the spinal cord is a small space called the epidural space. This is where the medication is placed.
When a disc bulges, arthritis builds up, or the canal narrows, those nerve roots can become irritated. This may cause:
- Low back pain
- Pain shooting into the buttock or leg, often called sciatica
- Numbness, tingling, or a heavy feeling in the legs
An epidural injection usually contains:
- A corticosteroid, to help calm inflammation around the nerves
- A local anesthetic, to numb the area and give short-term relief
- Sometimes a small amount of saline, to help spread the medicine
The anesthetic may give quick relief for a few hours. The steroid usually takes longer to work, often several days, and may provide relief that lasts weeks or sometimes longer. Epidural injections do not fix the underlying condition, but they can ease symptoms caused by problems such as herniated discs, spinal stenosis, degenerative disc disease, and some kinds of post-surgical back or leg pain.
Who May Be a Good Candidate for Epidural Injections
Not every type of back pain responds the same way, so careful evaluation is important. You may be a possible candidate for an epidural injection if you have:
- Back pain that travels into the buttock, thigh, or leg
- Pain that gets worse with standing or walking and may ease when sitting or bending forward
- Symptoms that have not improved enough with rest, physical therapy, or medications
We also look at:
- Your overall health and medical history
- Results from imaging, such as an MRI or CT scan
- How much pain affects your work, sleep, or daily tasks
In our Garden City office, we tailor the injection plan to the individual. There is no single formula that fits everyone, and sometimes an epidural is not the right choice. People with uncontrolled diabetes, bleeding disorders, certain infections, or those who are pregnant or on specific blood thinners may not be good candidates. A careful medical review helps us decide if the benefits are likely to outweigh the risks.
What to Expect Before, During, and After Your Injection
Before the procedure, we start with a detailed visit. We review your symptoms, medical conditions, and medications, including blood thinners and supplements. We also review any imaging, which helps us choose the safest and most effective level and side of the spine to target. The injection is usually done with imaging guidance such as fluoroscopy, which is a type of X-ray.
During the injection, most patients are awake but comfortable. The typical steps are:
- You lie face down or slightly on your side on a procedure table
- The skin over your back is cleaned with an antiseptic solution
- We numb the skin with a small amount of local anesthetic
- Using live X-ray, we guide a thin needle into the epidural space
- A small amount of contrast dye is injected to confirm correct placement
- The steroid and anesthetic mixture is then slowly injected
The procedure usually takes only several minutes once everything is set up. Many people describe a feeling of pressure, not sharp pain, as the medicine goes in.
After the injection, you rest for a short observation period. Some common experiences include:
- Mild soreness or pressure at the injection site
- Temporary numbness or weakness in the legs while the anesthetic wears off
- Tiredness for the rest of the day
You will need a ride home if any sedation is used. Most people can return to light activities later that day or the next, but we often suggest avoiding heavy lifting or intense exercise for a short time. Some notice immediate relief, while others feel improvement over several days as the steroid starts to work. A brief flare of pain can happen before things settle down.
Safety, Risks, and Common Myths About Epidural Injections
Epidural injections are generally considered safe when performed by a trained pain management physician, but no medical procedure is risk-free. Possible risks include bleeding, infection, headache, or temporary nerve irritation. Serious problems are rare, but they are important to discuss.
Mild, short-term side effects are more common and may include:
- Soreness at the injection site
- Facial flushing or feeling warm
- Trouble sleeping for a night or two from the steroid
- Brief changes in mood or blood sugar in some people
There are also a few myths that can scare people away. Epidural injections do not destroy the spine, do not automatically mean that surgery is next, and they are not the same as epidurals given for childbirth. The medication dose and approach are different.
In our practice, we use sterile technique, imaging guidance, and careful dose selection to lower risk as much as possible. We also coordinate with your primary care doctor and other specialists so your full health picture is taken into account.
Integrating Epidural Injections Into a Long-Term Pain Plan
Epidural injections are one tool, not the whole toolbox. For many people, the best results come when an injection is part of a broader plan that can include:
- Physical therapy and guided exercise
- A home exercise routine focused on core strength and flexibility
- Attention to posture, body mechanics, and ergonomics at work and home
- Targeted medications when appropriate
- Lifestyle steps such as weight management and smoking cessation
Pain relief from an injection can open a window of opportunity. With less pain, it is often easier to work on strength, balance, and movement patterns. This can help support your spine and may reduce the chances of another strong flare.
There are usually limits on how often steroid injections should be given in a year. We also pay attention to blood sugar, blood pressure, and other health factors, especially in people with conditions like diabetes or heart disease. Over time, we follow patients and adjust the treatment plan as needed, aiming for more stable, steady improvement in pain and function, not just quick fixes.
Take the Next Step Toward Lasting Pain Relief
If back or neck pain is limiting your daily life, we can help you find a safe, evidence-based solution. Learn how epidural steroid injections may fit into a personalized treatment plan designed around your specific condition and goals. Dr. Edward Rubin sees patients from throughout Nassau County, Queens, and Long Island at our Garden City and New Hyde Park offices, taking the time to explain your options clearly so you can make confident decisions about your care. Call us at 516-492-3100 or text 516-206-0774 to schedule a consultation — same-week appointments are often available for new patients.
Written by Dr. Edward Rubin, MD, board-certified in Pain Medicine and Anesthesiology, with fellowship training at Cornell, Columbia, Hospital for Special Surgery, and Memorial Sloan Kettering. Dr. Rubin has been treating chronic pain patients on Long Island for over 20 years.
