What To Do When Epidural Steroid Injections Don’t Work?

Narayani Bhardwaj
Narayani Bhardwaj Guide
23 Min Read

Epidural steroid1 injections provide an anti-inflammatory steroid directly around the epidural space of the spinal cord. It causes pain while injecting steroids in the spine area before providing relief.

For some people, epidural steroid injections do not offer quick relief from pain, and the effects of these can be short-term or may not be therapeutic. At the same time, steroid injections are used in various pain management treatments.

Sometimes, these injections fail to work for every person. Various effective ways and treatments can be taken when epidural injections don’t work. 

1. What are Epidural Steroid Injections?

Epidural steroid injections are used to treat chronic pain. A professional physician injects the steroid into the epidural part of the spine in this procedure. This steroid is an anti-inflammatory medicine that helps relieve chronic pain, which is mixed with anesthetic2.

The steroid eases pain and lowers discomfort as the medicine expands in the space while reducing inflammation. Steroid injections are specially developed to provide relief of pain for a longer time, which can last several months.

Pain management healthcare providers use epidural steroid injections to lower back pain. Conditions like lumbar spinal stenosis do not get cured with these injections, but they are used to reduce the pain and burning sensation in the back.

Also, epidural steroid injections do not work for everyone. As a result, one has to get multiple shots within months. Multiple steroid shots weaken the bones located near the spine and tissues. So, a few shots of this injection are given in a year. 

2. Ailments that Can Be Treated with Epidural Steroid Injections

Back pain may be complex, as the nerves and spine can be delicate. Nerves in the body, especially around the spine, have a complex nature and can show more symptoms than pain in cases of spine conditions.

These symptoms include:

  • Muscle cramps
  • Pain in feet or hands
  • Prickling sensation and itching
  • Numbness
  • Pain going down the legs and arms

Steroid injections can be helpful to treat pain in the entire body. Patients with back pain and chronic joint pain3 often find these steroid injections helpful. However, epidural steroid injections are specially used to inject steroids in the epidural space.

Epidural steroid injections are beneficial for treating various ailments. Some of the common conditions are listed below:

2.1. Spinal Stenosis

An epidural steroid injection is helpful for an individual who is diagnosed with spinal stenosis. This condition must be treated as soon as possible as it may become chronic if not treated promptly. 

2.2. Herniated Disc

These steroid injections are also used to treat herniated discs4, which are also popularly known as slipped discs. Avoiding this condition can lead to severe leg pain, creating problems while walking.

2.3. Sciatica

When Sciatica5 is not treated correctly on time, this condition can cause significant weakness in the legs. These injections are also helpful to deal with Sciatica.

2.4. Lumbar Radiculopathy

When there is a problem in the lumbar spine6, an epidural steroid injection is an adequate treatment that can help treat the condition for a certain period. Several nerve issues can be developed if the condition is not diagnosed on time. 

Lumbar Radiculopathy: Treating Pain and Numbness in Legs

2.5. Bone Spurs

Bone spurs are conditions in which extra growth of bones can lead to inflammation and pain in that area.

2.6. Spondylolisthesis7

In this condition, the backbones can slip out of place a little or more, putting pressure on the spinal canal. This condition can cause symptoms related to the nerve, like numbness, and can cause mild to severe pain.

Degenerative Spondylolisthesis - Patient Animation

A doctor can diagnose and treat these conditions in various ways, depending on the spinal conditions of the person.

Any condition that involves chronic pain, inflammation, or burning sensation due to nerve compression can be relieved with steroid injections.

However, in problems like diabetes or high blood pressure, a doctor’s decision may be influenced.

3. Why Do ESIs Not Work?

Epidural steroid injections are not found to be effective on each person, says a lot of studies. They failed to provide long-term relief to various patients, especially those suffering from lumbar spinal stenosis.

Repetitive dosages may provide relief for the short term but do not cure the main root of the problem. Conditions in which the spinal canal narrows are due to the thickening of ligaments, which compresses the nerves and puts pressure on tissues and muscles, creating pain.

Spinal Injections for Back Pain- Why They Don

Decompression is necessary to relieve pressure and reduce narrowing conditions. Steroid injections hide the pain, provide relief for a certain period, and detain long-term relief, especially when taken repetitively.

Epidural steroid injections have been a way for decades to treat severe pain. However, it is found that there are some harmful substances in the injections. Repetitive shots of these injections can affect an individual’s body differently.

Also, physicians try to lower the use of steroids to avoid numerous complications in the future. Many physicians put a limit on the use of the number of steroid injections they will offer. It does not cure the underlying issue and does not provide long-term relief.

4. Side Effects of Steroid Injections

Before starting with any treatment, it is good to know the possible side effects related to it. Injecting steroid may show some effects like given below:

  • Fatigue and fainting
  • Dizziness
  • Nausea and feeling of getting collapsed
  • Minor pain in the injected space
  • Restlessness
  • Anxiety and irritation
  • High Blood Sugar
  • Headaches
  • Allergic Reactions
  • Enhanced Pain

Side effects from corticosteroids

Everybody doesn’t need to experience these symptoms. Consulting with your healthcare provider is always a beneficial choice, as symptoms can vary from person to person and are not easy to detect yourself.

5. Things to do When Epidural Steroid Injections Don’t Work

Epidural Steroid Injections are found to be helpful in a variety of health conditions, but they may not be effective for everyone. Given below are the things that one can consider when epidural steroid injections do not work:

5.1. Consult your Physician

When the steroid injections do not work, it is better to consult your physician. If necessary, your physician will prescribe another steroid injection. However, sometimes, it may take various treatment rounds to see the results.

They can also recommend other types of treatments or transfer you to a pain management healthcare provider for additional help when ESIs do not work.

Further, it is also an essential question of how many steroid injections one should take in the entire lifetime to avoid future complications. However, the number of injections one should take depends on the person and condition.

Taking countless steroid injections is harmful to health; it may show severe effects in the future.

5.2. Non-Surgical Treatments

Non-surgical treatments depend on the condition of the spine or back and the symptoms you are facing. These treatment options include acupuncture, pain medication, and chiropractic care. However, physical therapies are also a part of non-surgical treatments.

5.2.1. Acupuncture

Acupuncture therapy originated in China and started around 2,500 years ago. This therapy includes placing needles on specific points of the body to relieve pain, known as acupuncture points.

It is believed that during acupuncture, the central nervous system provides some effects that help feel relief in pain. It can trigger the liberation of chemicals in the spinal cord, brain, and muscles.

These chemicals modify the pain experience or make changes in the body, which can promote a sense of good health. People suffering from pain can undergo acupuncture therapy every day to get quick relief.

5.2.2. Pain Medications

In case of minor lower back pain, antidepressants can be helpful to reduce pain. Pain medication is a valuable option when there is minor back pain. Antidepressants are used to treat anxiety, depression, and other types of disorders, including chronic pain.

5.2.3. Chiropractic Care

Chiropractic Care is a practical approach involving diagnosis, treatment, and prevention of mechanical issues in the body. It is an effective care for the musculoskeletal system, especially the spine.

What is chiropractic?

Healthcare providers who provide chiropractic care are known as Chiropractors. They generally alter the alignment of the body to provide pain relief. It also improves the functioning of the body itself.

The main focus of chiropractic care is spinal manipulation. However, chiropractic care includes various other treatments, such as postural exercises, patient education, manipulative therapies, and convenient training. 

5.3. mild®

mild® is an alternative procedure that can be used when epidural steroid injections don’t work. mild® symbolizes minimally invasive lumbar decompression. It is a mini rehabilitative procedure that relieves pressure around the spine.

Minimally Invasive Lumbar Decompression (mild®) for Back Pain

This procedure reinstalls the space in the spinal canal, relieving pressure on the nerves and spinal cord. This procedure is recommended for severe conditions under the guidance of a professional physician.

It involves a procedure in which a segment of thickened ligament or a portion of bone is removed, compressing the nerve to reinstall the space in the spinal canal.

5.4. Surgeries

Surgeries are the last option when no treatment seems to work. They are not recommended for treating minor conditions. However, when multiple steroid injections fail to provide pain relief, surgery can be considered only after the recommendation of your physician.

5.5. Physical Therapy

Physical therapy is another treatment that may be useful when injections don’t work. It is one of the best ways to treat different health conditions. However, it is better if this type of treatment is considered before injecting with steroids.

Physical therapies are often found useful to treat various kinds of pain in the body. You can enroll in a physical therapy center to get this treatment. Regular therapies will strengthen the muscles and ligaments and make them flexible around the back.

When appropriately done regularly, the pain will likely go away slowly.

5.6. Bed Rest

Bed rest is a good option for low or mild back pain. Getting doses of steroids frequently isn’t a good idea. When there is minor pain, bed rest is suggested. Lie horizontally on the bed or in a position that relieves you.

However, bed rest should also be limited, as not moving for too long can slow recovery. In some cases, too much bed rest can increase pain and cause. 

5.7. Heat and Cold Therapy

There can be numerous causes for back pain; it is not necessary to get steroids for each kind of pain. Depending on the condition, the healthcare provider may suggest you apply ice, heat, or a combination of both when these injections do not work.

Heat & Cold Therapy For Pain and Injuries

Remember to limit your time applying an ice pack or heating pad to protect your skin from burning or cooling sensations. 

5.8. Exercises

Exercise is the least preferred option when a person is experiencing back pain. However, exercises can increase the spine’s mobility and strengthen the core muscles and nerves, lowering back pain.

Exercise is always recommended to prevent back problems, but it can be tried in cases of less pain. Also, you may not need steroids for such minor conditions.

5.9. Alternative Therapies to Reduce Back Pain

There can be some other options that do not only provide pain relief but can be effective as an underlying treatment as well. Regenerative therapies use the body’s inner parts to cure the condition. Given below are the regenerative therapies that may be beneficial to treat spine conditions:

5.9.1. PRP Therapy

PRP stands for Platelet-Rich Plasma8, a kind of regenerative therapy. Blood has various components, one of which is known as “platelets.” Platelets are cells that contain protein and ten kinds of healing factors, which are helpful in reducing inflammation.

Platelet-Rich Plasma (PRP) Injections | Q&A

Along with these cells are fibroblasts and mesenchymal stem cells9, which help in various spine procedures. In this therapy, platelets-rich blood is drawn from the body. These platelets are then concentrated, and this concentrated PRP solution is injected into the affected area.

5.9.2. Mesenchymal Stem Cell Therapy

The mesenchymal stem cells are spread throughout the entire body and can assist in regenerating the cells once they have been damaged. Cells are obtained from the bone marrow. Then, these cells are processed and injected into the part where there is pain.

MSc Cell & Gene Therapy

The grown amount of regenerated cells can assist in recovering the damaged cells while lowering pain simultaneously.

6. Pros and Cons of Epidural Steroid Injections

There are some benefits and limitations of epidural steroid injections that must be considered before taking this injection. These pros and cons are listed below:

Ease Chronic Back Pain With Epidural Steroid Injections

6.1. Benefits

Several benefits of epidural steroid injections are listed below:

  • ESIs can provide temporary to long-term relief of spinal pain.
  • In case of minor to mild pain conditions, it can help avoid the risk of surgeries.
  • It improves the ability to move as it relieves pain after the injecting procedure.
  • It can assist physicians in knowing the root cause of the pain, which is often an issue with spinal pain.

6.2. Limitations

There are a few limitations related to the epidural steroid injections, which are given below:

  • A person may experience a short-term increase in pain after the procedure.
  • There may be a slight low-level radiation out of X-ray guidance.
  • A person may face some reactions due to the injected steroids.
  • Bleeding might occur from the nicked blood vessel.
  • Headaches due to steroids are rare, but they might occur.
  • I may get an infection at the injection place.
  • There may be a short-term paralysis of the nerves, which can result in the bladder or bowel.

7. Why Does Pain Increase After Taking Epidural Steroid Injections?

 According to a 2022 study, it is stated that up to 18% of people feel an increase in pain for a few days after getting a cervical injection. The absolute reasons for the increased pain are not stated well.

However, the epidural space is a small space where doctors inject steroids. The nerves are already affected and inflamed in this space, so when the doctors inject steroid fluid into it, it may lead to a temporary increment of pain for a few days, which may annoy spinal nerves.

Also, the effects of epidural steroid injections after the procedure may remain unpredictable as these injections do not cure the pain. Sometimes, the effects are not immediate, but they may improve well-being due to reduced pain later.

According to a 2019 study, injecting IV anesthesia and epidurals showed similar effects. Results were quite similar for both groups, the one with IV anesthesia and the other with epidurals.

8. How Long Can Epidural Injections Last?

Depending on the different spinal conditions, the duration of pain relief provided by an epidural steroid injection differs. It also revolves around the medications used in treatment and the person’s response to the treatment.

The steroid injections may provide short-term effects, lasting from a few days to several months. For a certain period, a person can require repetitive shots of injections to manage pain relief in conditions related to the spine.

Some people may get quick relief in the symptoms of spine conditions and pain after getting injected with steroids, while other people may take a few days or weeks to experience lower pain.

Further, a person must know that epidural injections are not the permanent solution to lower any pain related to the spine. Also, these are used as a part of long-term treatments, which include medications, physical therapies, and other intermediations. 

9. Risks Associated with the Epidural Steroid Injections

However, risks related to epidural steroid injections are rare. However, the following are some complications that may occur:

  • Building up of blood clots.
  • Blisters in the epidural space.
  • Itching or tingling sensations in the limbs.
  • Inflammation around the spinal area or brain fever might occur.
  • Incorrectly placed steroid injections can lead to mild to severe symptoms.
  • Burning sensation in the membrane, which protects the spinal cord.
  • A wrongly placed injection into the artery instead of the spine.
  • Feeble and fragile ligaments, tendons, and bones.
  • Sometimes, it can lead to decreased bone density, known as osteoporosis.
  • Skin becomes thin.
  • Fluid retention.
  • Hyperglycemia or high blood sugar.

What Are The Risks Associated with Epidural Steroid Injections? - Common Back Pain Questions

10. Is the Prevention of Pain Possible After an Epidural?

The doctor injects an anesthetic along with the steroid, which is used to numb the area around the spine for several hours. The pain can be throbbing while injecting the steroid, and it can increase.

To relieve this throbbing pain, you can take over-the-counter medications after consulting with the doctor. Also, an ice pack can be applied to the area 3-4 times a day to reduce the burning sensation.

However, it is better to rest at home. It is essential to consult with the doctor if there are any restrictions on the body movements. Further, one can try to lie on one side to manage the pain and get comfort or the other side by placing a pillow between the knees.

11. Conclusion

Many people nowadays suffer from back pain regularly. There are times when pain is too much to bear, and it affects a person’s daily routine. However, seeing a pain management specialist to treat the pain is essential.

Epidural steroid injections are often used to treat severe pain around the spine area. However, these injections sometimes fail to work for different persons and do not work. A person should consult the physician when the steroid injections don’t work.

Several ways mentioned above are found helpful and can be treated as alternative ways to treat pain other than epidural steroid injections. Further, always consult your physician first, as they may be able to help you with alternative treatments without the use of steroid injections.

  1. Carassiti, Massimiliano, et al. “Epidural steroid injections for low back pain: A narrative review.” International Journal of Environmental Research and Public Health 19.1 (2021): 231. ↩︎
  2. Lim, Byung-Gun, and Il-Ok Lee. “Anesthetic management of geriatric patients.” Korean journal of anesthesiology 73.1 (2020): 8. ↩︎
  3. Filatova, E. S., and A. M. Lila. “Contribution of neurogenic mechanisms to the pathogenesis of chronic joint pain.” Modern Rheumatology Journal 15.2 (2021): 43-49. ↩︎
  4. Yoon, Wai Weng, and Jonathan Koch. “Herniated discs: when is surgery necessary?.” EFORT Open Reviews 6.6 (2021): 526-530. ↩︎
  5. Aguilar-Shea, Antonio L., et al. “Sciatica. Management for family physicians.” Journal of family medicine and primary care 11.8 (2022): 4174-4179. ↩︎
  6. Momin, Arbaz A., and Michael P. Steinmetz. “Evolution of minimally invasive lumbar spine surgery.” World neurosurgery 140 (2020): 622-626. ↩︎
  7. Akkawi, Ibrahim, and Hassan Zmerly. “Degenerative spondylolisthesis: a narrative review.” Acta Bio Medica: Atenei Parmensis 92.6 (2021). ↩︎
  8. Everts, Peter, et al. “Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020.” International journal of molecular sciences 21.20 (2020): 7794. ↩︎
  9. Rodríguez-Fuentes, David E., et al. “Mesenchymal stem cells current clinical applications: a systematic review.” Archives of medical research 52.1 (2021): 93-101. ↩︎

Last Updated on by Sanjana

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