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Know when to consult a doctor.

Epidural steroid injections have been prescribed to treat back pain for a long time. Several patients have benefited from epidural steroid injections for pain relief. Many people have benefited by not having surgeries. Success with epidural steroid injections rather than surgery has allowed many professional athletes to resume their careers.

 They are frequently administered as a series, denoting a collection of injections spaced out at regular intervals. Occasionally, one might require repeated injections. However, there are disadvantages to the widespread use of epidural steroid injections. Despite claims to the contrary, there are risks associated with the procedure. Continue read to know the risk & dark side of epidural steroid injection and when to consult a doctor. 

What is Epidural Steroid Injection?

Epidural steroid injections are a popular method for neck and back pain. These injections typically place steroids in the spine’s epidural space. The epidural space is a sac that surrounds the spinal cord and contains nerves, blood vessels, and fat. Epidural steroid injections in the cervical, thoracic, lumbar, or sacral regions of the spine are possible. The skin over the treatment site is cleaned, then anesthesia is injected to numb the area before the injection.

What Kinds of Risks and Complications Could Epidural Steroid Injections Possess?

The following are potential side effects & dark side of epidural steroid injection:

  • The Risk of Bleeding – 

The possibility of contracting an infection exists where the injection was made. The injection site is completely sterile and made bacteria-free before inserting the needle. Additionally, one is typically given antibiotics before the procedure. Even with that, there is a chance of getting sick. There is a chance that the infection will spread to the spine and the brain, particularly if there is an underlying skin condition. It’s also possible for the nearby bones and flesh to develop an abscess with purulent accumulation.

The syringe can occasionally puncture the dura. Usually, it closes up within 2 hours, leaving the patient symptom-free. The cerebrospinal fluid, a substance that helps fill the gap between the brain parenchyma layers and nurtures the spinal cord, may transmit out from this puncture site, which could result in a spinal headache if it doesn’t. Considering that the fluid is replaced every six hours, it is not a serious issue. 

When a person experiences severe headaches when trying to stand up and disappear after lying down, they likely have spinal headaches. One should consult a physician and get the necessary care. The doctor might need to perform an extradural blood patch if it continues. Caffeine may be beneficial for treating spinal headaches.

This is incredibly untypical. However, a steroid injection into the epidural space has occasionally caused paralysis in patients. When a drug is directly injected into the spinal cord, it permanently harms it. The patient will typically feel it if the pain doctor accidentally touches the nerve root while administering the steroid medication.

In such a case, one must inject the medication by slightly pulling back the needle. Unusual sensations, seizures, or a loss of sensation are all possible. The annoyance may linger for just a few days but quickly passes.

  • Cauda Equina Syndrome – 

Due to nerve damage, this is a rare side effect of epidural steroid injection. After receiving an epidural steroid injection, one may lose the ability to urinate or bowel. Even though it is a very uncommon condition, it is crucial to see a doctor immediately because if you don’t, it could result in lower body paralysis.

  • Pain From Injection and Allergies –

As the numbing medication wears off, there is a localized pain in which the needle punctures the skin. The discomfort might last for some time. The area may also feel numb and swollen, but this is only temporary. To lessen the discomfort and swelling, one can apply cold compression.

During the procedure, one may infrequently experience low blood sugar and a slow heartbeat. The local anesthetic that was injected into the patient could become extremely toxic. Additionally, there is always the chance that taking the medication could cause a fatal allergic reaction.

What is the dark side of epidural steroid injection?

The steroid is a massive benefit for situations like spinal stenosis or radiculopathy that result from inflammation. With its anti-inflammatory properties, it bathes the nerve root, numbing it.

However, steroid therapy has some unwanted effects, such as:

  • The steroid medication may temporarily worsen your pain before it begins to work.
  • You might experience bruising or tenderness where the injection was made.
  • The exposure to low-level radiation from the X-rays will be minimal if your doctor uses fluoroscopy for visualizing guidance.
  •  Fluoroscopy x-rays could harm developing children. Before the procedure, it’s crucial to let your doctor know if you are or think you might be pregnant.
  • An epidural steroid medication will probably result in high blood sugar if you have diabetes (hyperglycemia). It might go on for several hours or days.
  • An ESI may suddenly raise your pulse rate and eye pressure if you have glaucoma.
  • Any performance-enhancing drug medication has the propensity to make people gain weight. One might develop fat deposits on the back, stomach, shoulders, tummy, and face.
  • The steroid may cause stomach ulcers if a person is predisposed to them.
  • Lack of sleep and exhaustion.
  • headache and lightheadedness

Can long-term complications result from receiving an ESI injection?

Even though they are extremely uncommon, long-term effects from having received an epidural steroid injection might include the following:

  • Epidural injection-induced spinal cord or neurological dysfunction damage that results in a lifelong neurologic deficit.
  • Chronic pain brought on by epidural injection-induced spine or nerve root damage.
  • Hematomas, which develop when an accumulation of blood between the dermal layer and the spinal cord, can result in permanent paralysis.

What is the prognosis (outlook) for treatment with epidural steroid injections?

There are different stages of outcomes for ESIs because there are numerous chronic pain causes that an ESI may be able to help treat and because each person is unique. However, pain relief is reported by about 50% of those who receive an ESI.

What is the duration of an epidural steroid injection?

According to available research, epidural cortisone injections are effective at relieving pain, but the duration of that relief may vary. This is particularly reliant on what is causing the pain in the first place. While rarely lasting up to a year, the pain relief could last a few weeks to months.

Although you may receive more than one ESI, most healthcare providers only allow two to three ESIs per year for most patients. Most of the time, ESIs do not eliminate the source of your pain. People with chronic pain who receive ESIs frequently require additional therapy for long-term pain relief.

When should one see the doctor?

  • After receiving your ESI injection and returning home, call your health professional or head straight to the hospital if you notice any symptoms.
  • Having an intense headache while sitting or standing that gets better when you lie down. This might indicate a dural puncture.
  • Experiencing a viral infection, which could indicate an infection.
  • Having diminished or lost urethra or bowel control completely.
  • Noticing weakness or numbness in one’s legs may indicate a nerve injury.


Even though epidural steroid injections are a great way to treat chronic nerve pain, using them excessively can have negative side effects. Some people have observed that the procedure loses some effectiveness after repeated use. The best treatment for spinal stenosis and others involves surgical removal of the underlying cause. 

Along with a dark side of epidural steroid injection you can consult a doctor for prescribed use of it.

Additionally, the steroid injection only reduces pain and inflammation; it does not treat the underlying cause. Make it a point to have the procedure performed in a reputable medical facility under the supervision of professionals.

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