Epidural steroid injection (for back pain or sciatica) (Epidural corticosteroid injection)
An injection of steroid, usually with local anaesthetic, around the nerves in the spine to ease leg or arm pain from an irritated nerve.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An epidural steroid injection aims to ease leg or arm pain from an irritated spinal nerve, such as sciatica, by calming inflammation around the nerve.
- It treats the pain, not the cause; the benefit is often partial and temporary, and many cases of sciatica improve over weeks anyway.
- NICE supports considering it for acute, severe sciatica, but advises against it for ordinary back pain without nerve pain and for the leg symptoms of central spinal canal narrowing.
- Serious complications are rare but important, so it is worth understanding the trade-offs and the warning signs, especially a severe headache or new weakness after the injection.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can reduce nerve-related leg or arm pain, such as sciatica
The pain is ordinary low back pain without nerve pain, where epidural injections are not recommended.
Your leg or the area may feel numb, heavy or weak from the local anaesthetic, and your blood pressure and strength are checked before you go home. Do not...
Clear written warning signs and a named out-of-hours contact for serious symptoms.
Your leg or the area may feel numb, heavy or weak from the local anaesthetic, and your blood pressure and strength...
Rest and take it easy. Some people have a short increase in pain before it settles. Keep the dressing dry for the...
Any steroid effect usually begins to come on over several days. Gradually return to gentle activity as comfort...
If it helps, use the period of less pain to stay active and do physiotherapy. The amount and length of benefit...
What is an epidural steroid injection?
An epidural steroid injection puts anti-inflammatory steroid, usually mixed with local anaesthetic, into the epidural space, the area just outside the covering of the spinal nerves. It is given by a pain specialist or other doctor, usually with X-ray (or sometimes ultrasound) guidance to place the needle accurately.
It is mainly used for pain that travels down a leg (sciatica) or an arm because a spinal nerve is irritated or pressed on, often by a slipped (herniated) disc. By calming inflammation around the nerve, it can reduce the pain. NICE supports considering an epidural injection of local anaesthetic and steroid for people with acute and severe sciatica.
The injection treats the pain, not the cause. It does not remove a disc bulge, widen a narrowed spine or cure the underlying problem, and the benefit is often partial and temporary. Many cases of sciatica improve over weeks anyway, so the injection is one option among several, not a routine first step.
It is not recommended for ordinary low back pain without nerve pain, and NICE specifically advises against using epidural injections for the leg symptoms of a narrowed central spinal canal (neurogenic claudication). It is best used as part of a plan that includes staying active, physiotherapy and, for some, consideration of surgery.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Epidural steroid injection vs surgery for disc-related sciatica
| Question | Epidural injection | Surgery (discectomy) |
|---|---|---|
| Invasiveness | Injection, day case | Operation under anaesthetic |
| Aim | Calm nerve inflammation | Remove the disc pressing on the nerve |
| Effect on pain | Often partial, may be temporary | Can be more lasting for some |
| Serious risks | Rare | Higher than an injection |
A trial (NERVES) found injection and surgery gave broadly similar results for many people, with fewer serious problems after injection. Your specialist will help you weigh them up.
Preparing for your injection
- Tell the team about any blood-thinning medicines, as these often need to be paused and planned around the injection.
- Mention diabetes, as the steroid can raise your blood sugar for a few days.
- Tell them about any infection, fever or feeling unwell, and any allergy to steroid, local anaesthetic, X-ray dye or skin-cleaning fluid.
- Let them know if you are or might be pregnant, as X-ray guidance uses radiation.
- Arrange for someone to drive you home and stay with you, especially if you may have sedation.
- Ask whether to keep taking your usual medicines and painkillers, and bring a list.
- Wear comfortable, loose clothing and expect to lie face down or on your side for the injection.
What happens
You usually lie face down or on your side. The skin over your spine is cleaned and numbed with local anaesthetic. Using X-ray guidance to find the right spot, the specialist passes a fine needle into the epidural space, often using a small amount of X-ray dye to check the position, and then injects the steroid and local anaesthetic. You may feel pressure or a brief ache, or a short-lived pins-and-needles feeling down the leg or arm.
The injection itself usually takes about 15 to 30 minutes. Afterwards you rest and are watched for a short time, for example to check your leg strength and blood pressure, before going home the same day. A small dressing covers the needle site.
If local anaesthetic was used, your leg or the area may feel numb or weak for a few hours; this wears off. The steroid then takes a few days to have any effect. You should not drive on the day of the injection, particularly if you have had sedation.
Is this injection right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The pain is ordinary low back pain without nerve pain, where epidural injections are not recommended.
- The leg symptoms are due to a narrowed central spinal canal (neurogenic claudication), where NICE advises against epidural injections.
- There is an infection at the site or elsewhere, or an uncontrolled bleeding tendency.
- There are progressive nerve problems, such as worsening weakness or loss of bladder or bowel control, which need urgent assessment rather than an injection.
- There is an allergy to the steroid, local anaesthetic, X-ray dye or skin-cleaning fluid.
Delay or rearrange if…
- You have an active infection, a fever or feel unwell.
- You are taking blood thinners that have not been safely paused or planned around.
- You are or might be pregnant, because X-ray guidance uses radiation.
- Your diabetes is poorly controlled, until this is discussed.
- You cannot arrange someone to take you home or be with you afterwards.
Alternatives to discuss
- Staying active, physiotherapy and a structured exercise programme.
- Painkillers or nerve-pain medicines, where suitable, and time, as many cases of sciatica settle.
- A nerve root block or different injection approach in selected cases.
- Surgery, such as a discectomy, for severe or persistent nerve pain or progressive symptoms.
- Watchful waiting with review if symptoms are improving.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can reduce nerve-related leg or arm pain, such as sciatica
- May make it easier to stay active and take part in physiotherapy
- Can, for some people, reduce or delay the need for surgery
- Targets the area around the affected nerve more directly than tablets
- Can help confirm which nerve is causing the pain when a single nerve root is injected
- Offers an option between simple measures and surgery while the problem is settling
Risks & complications
- Temporary increase in pain, or a short-lived flare, in the first day or two
- Soreness or bruising at the injection site in the back
- Numbness, heaviness or weakness in the leg or arm for a few hours from the local anaesthetic
- A flushed face for a day or two, and a few days of raised blood sugar if you have diabetes
- No improvement in symptoms for a proportion of people
- A 'dural puncture' headache, which is worse when sitting or standing and better lying flat
- Feeling faint, dizzy or sick around the time of the injection
- Steroid side effects such as fluid retention, mood or sleep changes, or a temporary period change in women
- Temporary worsening of symptoms before any improvement
- Infection at the injection site or, very rarely, a deeper infection such as an epidural abscess
- Bleeding causing a collection (epidural haematoma) that presses on the nerves
- Nerve injury causing lasting numbness, weakness or pain
- Very rarely, serious harm including paralysis, which is why the injection is done carefully and with image guidance
Most people have no serious problem, but the rare complications are important because they can be permanent, so consent should be a genuine discussion. The most urgent warning signs are a severe headache that is worse upright, new or worsening weakness or numbness in the legs, loss of bladder or bowel control, or signs of infection such as fever and severe back pain. The Faculty of Pain Medicine and British Pain Society stress informed consent, image guidance and, in the spine, attention to which steroid is used. Tell the team about blood thinners, diabetes, infection, pregnancy and allergies, and be clear that the injection treats the pain rather than the cause.
Published figures to discuss
Most epidural steroid injections cause no serious harm, but reliable numbers for the rare, serious complications are limited, and their importance lies in their severity rather than their frequency. The size and length of any benefit also vary widely, and a meaningful proportion of people get little relief. Sources such as the Faculty of Pain Medicine and British Pain Society emphasise informed consent and careful technique, including the choice of steroid in the spine, because of the small risk of serious neurological harm.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Meaningful pain relief at around 3 months | Modest benefit on average for disc-related sciatica; many people improve but a proportion get little relief | Benefit is often partial and temporary, and many cases of sciatica also improve over time without injection. | Guide sourcesClinical context |
| Avoiding surgery after injection for disc-related sciatica | In the NERVES trial, most people having an injection had not had surgery during the study period | Injection and surgery gave broadly similar results for many people, with fewer serious problems after injection. | Epidural steroid injections — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
| Serious complications (e.g. infection, bleeding, nerve injury, paralysis) | Rare, but reliable exact rates are limited and serious harm can be permanent | This is why image guidance, careful technique and clear warning-sign advice matter. | Epidural steroid injections — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually little physical recovery, but you should take it easy for a day or two and not drive on the day. Any benefit takes a few days to build and is often temporary, so the injection is best used as a window to get moving and do physiotherapy.
- A numb, heavy or weak leg for a few hours after the injection
- A short increase in pain in the first day or two
- Mild soreness or bruising in the back at the needle site
- A flushed face and, in people with diabetes, higher blood sugar for a few days
- Gradual rather than instant pain relief over the following days, if it works at all
Aftercare
- Arrange for someone to drive you home and do not drive on the day of the injection.
- Rest and take it easy for a day or two, then gradually return to normal activity.
- Keep the dressing dry and in place for the first day.
- Use simple painkillers for any short-lived flare, unless advised otherwise.
- If you have diabetes, check your blood sugar more closely for a few days.
- Use any pain relief to stay active and do recommended physiotherapy.
- Know the urgent warning signs and exactly who to contact, day or night.
- Someone to drive you home and stay with you
- Plan to rest for a day or two with help if needed
- Simple painkillers at home for any flare
- Blood sugar testing kit ready if you have diabetes
- A clear note of the urgent warning signs and an out-of-hours contact number
- A reminder of when your follow-up appointment is
Scars and how they heal
There is no surgical wound, only a needle puncture in the skin of the back, covered with a small dressing. Some soreness or bruising at the site is common and usually settles within a few days. Keep the area clean and dry for the first day, and watch for any spreading redness, swelling or discharge that could suggest infection.
⚠ Get urgent help if…
- A severe headache that is much worse sitting or standing and better lying flat (possible dural puncture)
- New or worsening weakness or numbness in one or both legs
- Loss of control of your bladder or bowels, or numbness around the buttocks or genitals (call 999, possible cauda equina)
- Severe back pain with a high temperature or feeling very unwell (possible infection)
- Spreading redness, swelling or discharge at the injection site
- Signs of an allergic reaction, such as a widespread rash, facial swelling or wheeze (call 999)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a worthwhile reduction in nerve-related leg or arm pain that makes it easier to move, sleep and take part in physiotherapy, usually coming on over a few days. For some people this also helps them avoid or delay surgery.
The benefit is often partial and temporary, commonly lasting weeks to a few months, and a proportion of people get little or no relief. The injection does not remove a disc bulge or widen a narrowed spine, so it does not fix the underlying cause. Because many cases of sciatica settle over time anyway, the aim is usually to ease severe pain during recovery, not to provide a permanent cure.
Any relief is usually temporary, often weeks to a few months, while the underlying problem settles or other treatments take effect. Repeat injections are sometimes considered if the first clearly helped, but there are limits on how often steroid is given, and they are not a long-term solution on their own. Lasting improvement comes from the underlying problem resolving, from rehabilitation, or, for some, from surgery, rather than from repeated injections.
Related tests, treatments or support
An epidural injection is usually one part of a plan that includes staying active, physiotherapy and pain management, and sometimes a discussion about surgery if symptoms persist or are severe. It is sometimes used to provide enough relief to get rehabilitation going. It is not combined with, or used as a substitute for, treatment of the underlying cause where surgery is clearly needed, for example if there are progressive nerve problems.
Follow-up & long-term care
A follow-up is usually arranged to assess how much the injection helped and for how long, and to decide on next steps such as continued physiotherapy, a repeat injection within limits, or referral for a surgical opinion. Before then, you should seek urgent help if you develop any of the warning signs rather than waiting for the appointment.
- Keeping up physiotherapy and an active rehabilitation programme
- Staying within recommended limits if repeat injections are considered
- Managing weight, posture and activity to reduce strain on the spine
- Reviewing whether a surgical opinion is needed if symptoms persist or worsen
Repeat, follow-on and what comes next
- If the injection clearly helps but the pain returns, a repeat may be considered, but only within limits on how often steroid is given.
- If it gives little or no benefit, repeating it is usually not worthwhile and other options are considered.
- Persistent or progressive symptoms may lead to a surgical opinion rather than further injections.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written warning signs and a named out-of-hours contact for serious symptoms.
- A review to assess how well the injection worked and how long it lasted.
- Linking the injection to physiotherapy and an active rehabilitation plan.
- Honest discussion of limits on repeat injections and when a surgical opinion is needed.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether X-ray (fluoroscopy) or ultrasound guidance is used
- Whether the injection is done in a theatre or procedure room, and the facility fee
- The seniority of the pain specialist giving the injection
- Whether sedation is offered and used
- Whether a consultation and follow-up review are included
- Whether physiotherapy or further treatment is part of the package
- The number of levels or injections needed
- The consultation and the injection fee
- The facility or theatre fee and any imaging guidance charge
- Any charge for sedation
- Whether a follow-up review is included
- What happens, and what it costs, if a repeat injection is needed
- What support is available if a complication occurs
- The cancellation policy
On the NHS? Epidural steroid injections are available on the NHS, and NICE supports considering them for acute, severe sciatica; private injections are usually chosen for shorter waits or choice of clinician rather than because they are unavailable.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being led to expect a cure or lasting relief when the benefit is often partial and temporary.
- Not being told it is not recommended for ordinary back pain without nerve pain, or for central spinal canal narrowing.
- No clear discussion of the rare but serious risks, including nerve injury and, very rarely, paralysis.
- No written warning signs or out-of-hours contact for a severe headache, new weakness or signs of infection.
- Not being warned about driving, sedation and the need for someone to be with you afterwards.
Marketing red flags
- Promoting the injection as a cure for sciatica or a slipped disc.
- Offering it routinely for ordinary back pain without nerve pain.
- Describing it as pain-free or without risks, or downplaying the rare serious complications.
- Selling a course of repeated injections upfront rather than reviewing after one.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- How likely is this injection to help my particular pain, and by how much?
- How long might any benefit last, and what is the plan if it does not work?
- How does this compare with continuing physiotherapy or considering surgery for me?
- Which approach and which steroid will you use, and why?
- What are the serious warning signs and exactly who do I contact, including out of hours?
- How many injections could I have, and how far apart, given the limits on steroid?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my injection, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this injection not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is an epidural steroid injection available on the NHS?
How long does the relief last?
Will it cure my sciatica or slipped disc?
Is it dangerous? What are the serious risks?
Should I have an injection or surgery for sciatica?
Can I drive home afterwards?
Find a verified specialist for epidural steroid injection (for back pain or sciatica)
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG59 — Low back pain and sciatica in over 16s (recommendations) NHS — Sciatica Faculty of Pain Medicine — Patient information leaflets British Pain Society & FPM — Recommendations for good practice in the use of epidural injection (2021) Epidural steroid injections — StatPearls (NCBI) NERVES trial: transforaminal epidural steroid injection vs microdiscectomy for sciatica — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Steroid joint injection · Back and neck pain management · Botox for chronic pain · Chronic pain assessment and management · Complex regional pain syndrome (CRPS) management