Epidural Blocks

The best candidates have pain that travels from the back into a leg, or from the neck into an arm, caused by a herniated disc or narrowing around a nerve that matches their MRI or CT, and that has not improved after several weeks of physical therapy and medicines^[1][3]. Epidural injections are not recommended for back or neck pain that stays in the spine without spreading into a limb^[13].

An epidural steroid injection works by reducing inflammation around an irritated spinal nerve. A corticosteroid, usually mixed with a numbing medicine, is placed next to the nerve under live X-ray^[1]. The numbing effect wears off within hours, while the steroid aims to calm the nerve over the following days. It does not repair the disc, but it can ease pain enough for you to stay active while healing continues.

Tell us about every medicine you take, especially blood thinners. Epidural injections are intermediate bleeding-risk procedures, so some blood thinners may need to be paused^[12] — never stop one on your own; we coordinate with the prescribing doctor. Tell us if you have diabetes, since the steroid can briefly raise blood sugar^[13], or if you might be pregnant, and arrange a ride home.

Most people feel a brief sting from the numbing shot, then pressure rather than sharp pain. A transforaminal injection can briefly reproduce your familiar leg or arm pain. The procedure takes 15 to 30 minutes, and most patients need no sedation; Medicare’s policy notes that moderate or deep sedation is usually unnecessary^[3]. Soreness at the injection site for a day or two is common.

Relief varies widely. Some people feel better within a few days and stay better for a long time; others get little benefit. Research shows the clearest benefit in the first three months: a 2025 American Academy of Neurology review found that epidural steroids probably reduce short-term pain and disability from radiculopathy, with insufficient evidence for lasting pain relief^[8]. A repeat may be considered if one injection helped a lot.

Yes. Some people feel light-headed or faint during or soon after the injection — usually a brief vasovagal reaction that passes with rest^[7][13]. Headache and a temporary pain flare can occur^[7], and the steroid can briefly raise blood sugar^[13]. Some people notice facial flushing or poor sleep for a night or two. Call us for a severe headache when standing, fever or new weakness.

Relief is often temporary and may not come at all, and there is a small risk of complications. The FDA has not approved corticosteroids for epidural use and requires a label warning about rare but serious neurologic events, including paralysis, stroke, vision loss and death^[4][5]. Careful technique — live X-ray, contrast dye and the right choice of steroid — is designed to reduce that risk^[6].

Only a few per year in each region of the spine, and only if the last one clearly helped. Medicare’s policy for New York allows up to four sessions per spinal region in a rolling 12 months, with repeats only after at least 50% improvement lasting three months or more^[3]. New York workers’ compensation guidelines allow up to three per region per year^[13].

Your physician will first recheck the diagnosis — the pain may be coming from the facet joints, the SI joint or elsewhere. Physical therapy remains important. For a disc still pressing on a nerve, endoscopic discectomy or a surgical opinion may be discussed; for spinal stenosis, the MILD procedure; and for long-standing nerve pain, spinal cord stimulation.

Medicare and most commercial plans cover them when criteria are met. Medicare’s policy for New York requires nerve-root pain or stenosis symptoms supported by imaging, at least four weeks of conservative care, and image guidance with contrast; it does not cover injections for back or neck pain alone^[3]. Commercial plans often require prior authorization. Workers’ compensation follows New York’s Medical Treatment Guidelines^[13], and no-fault has its own rules.

Recovery is usually quick: you rest briefly, go home the same day and return to normal activities, including work, the next day. Plan not to drive yourself home — the numbing medicine can make a leg or arm feel weak, and you must not drive after sedation. Use ice for soreness, keep a simple pain log and continue your exercises; the injection is meant to help you stay active.