Getting an Epidural Steroid Injection: What to Expect
Epidural steroid injections (ESIs) are among the most commonly performed procedures in pain management, and for good reason — they're effective, well-tolerated, and can provide significant relief for back and neck pain with radiating symptoms. But many patients approach their first injection with anxiety because they don't know what to expect.
Let me walk you through the entire experience — from preparation through recovery — so you know exactly what's coming.
Before the Procedure
Medications: Tell our office about all medications you take, especially blood thinners (warfarin, clopidogrel, aspirin, or NSAIDS). Some blood thinners need to be held before the procedure. Diabetes medications may need adjustment as steroids can temporarily raise blood sugar.
Food and water: You can eat and drink normally before most epidural injections (unless you're receiving IV sedation, in which case you'll be NPO after midnight). We'll give you specific instructions.
Bring a driver: You cannot drive yourself home. Local anesthetic used during the procedure can affect your motor and sensory function for several hours.
Wear comfortable clothing: Loose-fitting clothes you can easily change in and out of. We'll give you a gown if needed.
The Day of the Procedure
When you arrive, a nurse will review your history, medications, allergies, and get your vital signs. You'll change into a gown and lie on the procedure table.
Local anesthesia: Before anything else, the skin and soft tissue are numbed with a small injection of local anesthetic. This is the "stick" — a brief sting, then numbness.
Needle placement under X-ray: Using fluoroscopic (live X-ray) guidance, Dr. Rubin advances the epidural needle to the target location. You may feel pressure — this is expected. Pain during needle advancement is uncommon.
Contrast confirmation: Before the steroid is delivered, a small amount of contrast dye is injected to confirm the needle is correctly positioned. You may feel a brief pressure or warmth.
The injection: The steroid (combined with local anesthetic) is injected. Some patients feel a familiar reproduction of their pain briefly — this means the medication is reaching the right nerves.
Total procedure time: approximately 15–30 minutes.
After the Procedure
You'll rest in the recovery area for 20–30 minutes while we monitor you. Most patients feel fine to leave after this observation period.
Expect the unexpected on day 1: Many patients notice a flare in pain the first day or two as the local anesthetic wears off and before the steroid takes effect. This is normal.
The steroid takes time: Anti-inflammatory effect from the steroid builds over 3–7 days. Most patients begin noticing improvement at the end of the first week.
Activity: Resume normal activities the next day. Avoid strenuous exercise for 48 hours. Ice (not heat) can help with any post-procedure soreness.
How Long Will It Last?
This varies considerably by patient and condition. Acute disc herniations often respond with relief lasting months to over a year. Chronic degenerative conditions typically provide shorter relief — 6–12 weeks — though this may be enough to participate in rehabilitation and allow natural healing to progress.
If relief is shorter than expected, we discuss the next step — whether that's another injection, a different approach, or a procedure like radiofrequency ablation for longer-lasting results.
Questions before your procedure? Call 516-492-3100 — we're happy to walk you through anything.