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How Do Lumbar Epidural Injections Help with Lower Back Pain?

An Integral Part of the Non-Surgical Management Options for Lower Back Pain and Sciatica

May 2024

Those who periodically suffer from lower back pain know the reality. Staying active and using over-the-counter pain relievers may often be sufficient to restore the quality of your life. With this approach, lower back pain usually fades away with time.

However, for some, home remedies fail to relieve the angry pain that confronts them each day. At that point, it becomes time to work with a doctor to figure out an individualized path for pain relief. 

Lumbar epidural steroid injections are one of the standard treatment options doctors consider for many forms of lower back and leg pain. They have been used since the 1950s. For doctors who are Physical Medicine and Rehabilitation specialists, they are considered an integral part of the non-surgical management of lower back pain and sciatica.

Illustration of the target area for epidural injection for back pain.

What Is a Lumbar Epidural Steroid Injection?

An epidural steroid injection of an anti-inflammatory medication (also called corticosteroid) into the lower back to relieve pain in the legs or lower back. The medication is injected using fluoroscopic (X-ray) guidance into the epidural space, an area of fatty tissue surrounding the spinal nerves.

A lumbar epidural steroid injection can help reduce nerve inflammation and stabilize membranes. It can reduce swelling and pressure on irritated nerves in the lower back. Corticosteroids decrease the production of inflammatory chemicals and reduce nerve fibers’ sensitivity to pain.

What Are Corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone our body’s adrenal glands and brain produce naturally. Corticosteroids are often referred to as “steroids,” but it is different from the anabolic steroid compounds that some athletes use to build muscles.

Corticosteroids are used to help reduce pain and inflammation as well as treat a variety of painful conditions, including lumbar disc herniation.

The Goals of a Lumbar Epidural Steroid Injection

The goals of a lumbar epidural steroid injection are to:

  • Relieve pain by reducing inflammation in and around nerve roots.
  • Help a patient improve their mobility and lower back function.
  • Improve leg mobility and function for sciatica sufferers.
  • Enable a patient to participate and progress in a comprehensive physical therapy program.

Commonly, lumbar epidural steroid injections are only recommended when a series of other more conservative treatments have been tried without adequate results.

What to Expect from a Lumbar Epidural Steroid Injection

For many patients, a lumbar epidural steroid injection can provide relief for intense episodes of back and/or leg pain. 

These injections are normally administered in an outpatient setting, usually under twilight sedation. A local anesthetic is used at the injection site, and fluoroscopic (X-ray) guidance precisely targets the medication to nerve roots in the epidural space of the back. 

It generally takes a few days after an injection before the medication begins to take effect and lower back pain improves. Pain relief often lasts at least three months and may extend for years. 

For some patients, one lumbar epidural steroid injection is all they need to resolve their back pain issues. If more than one injection is required, there usually is a limit of three or four a year.

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