14 Epidural Steroid Injection Side Effects (And How To Avoid Them)

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14 Epidural Steroid Injection Side Effects (And How To Avoid Them)

After rest, exercise, chiropractic and physical therapy, and treatment with non-steroidal anti-inflammatory drugs (NSAIDs), steroid injections are one of the most commonly performed treatments for back pain. While generally considered safe, epidural steroid injection side effects can occur. Knowing what the side effects of epidural steroid injections are is the first way to reduce the risk, but there are other ways to protect yourself.

Most common epidural steroid injection side effects

The most basic epidural steroid injection side effects include the following:

  • Infection and bleeding at the injection site
  • Sleeplessness
  • Headache
  • Anxiety
  • High blood sugar
  • Temporarily increased pain
  • Stomach ulcers
  • Cataracts

What’s the research on epidural steroid injections?

While these more common side effects are something to be aware of and work with your doctor to avoid, there are immense benefits of using epidural steroid injections for pain management. In medical school, doctors are taught the Hippocratic oath: “first do no harm.” By that measure, epidural steroid injections hit the mark. In a recent study of 4,265 epidural steroid injections performed in 1,857 patients, no major complications were found. Minor complications, such as increased pain or pain at the injection site, occurred in 2.4% of cases. More serious complications, including nerve injury, infection, or death have been reported, but represent a tiny fraction of those receiving this procedure.

Pain doctors have been studying epidural steroid injections for decades and there are over 45 placebo-controlled, scientific studies assessing thousands of patients to test their efficacy. Most of these studies found that epidural steroid injections were effective in relieving pain. You can review a list of these studies here in the Clinical Trials section of this page.

Additionally, some studies in which epidural steroid injections performed similarly to the control treatment delivered other potentially beneficial injections to the control group. Thus, the evidence from these studies does not necessarily contradict a therapeutic effect of epidural steroid injections — both groups may have received a helpful treatment. Like any medical treatment, there is a right and wrong time to any intervention.

The following video gives a great overview of how a balanced approach to epidural steroid injections can help you find relief, while avoiding common side effects.

Less common epidural steroid injection side effects

While those were the most common short-term epidural steroid injection side effects, more research has been uncovered in the last five years that looks at less common, but more serious side effects. These risks affect different populations at varying rates, so talk to your doctor about ways to prevent these side effects. Again, avoiding risks is part of a balanced approach to this pain management technique. Epidural steroid injections do work, and well, for many patients. Before using them, however, it’s important to know as much as you can about how they work and various risk factors.

1. Worse outcomes for some conditions

For patients with spinal stenosis, a major side effect of steroid injections may be worse outcomes and an increased chance of surgical intervention. Dr. Kris E. Radcliff and his colleagues at Thomas Jefferson University in Philadelphia had another finding. They found that patients who opted for epidural steroid injections (ESI), a common treatment protocol, were worse off, noting:

“Despite the common treatment practice of incorporating one or more ESI in the initial non-operative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis.”

2. Significant bone loss in postmenopausal women

Side effects of steroid injections may cause significant bone loss to the injection area in postmenopausal women, a Henry Ford Hospital study found. Shlomo Mandel, M.D., Henry Ford orthopedic physician and the study’s lead author, pointed out that epidural steroid injection side effects should be carefully considered when treating postmenopausal women, noting:

“The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility. Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient’s treatment plan.”

3. Steroid injections may be contaminated

A side effect of steroid injections is infection at the injection site. In 2012, however, the U.S. Centers for Disease Control and Prevention began receiving reports of fungal meningitis in patients receiving steroid injections. Fifty-eight of the 745 reported cases resulted in fatality, prompting a warning for all doctors and patients utilizing steroid injections.

However, this tragic and devastating outbreak was isolated to one pharmacy. An event like this is unprecedented in the 60-year history of this treatment, given that over eight million epidural steroid injections are done in the U.S. each year. Thankfully, even in the year of this tragic outbreak, fewer than one in 10,000 epidural steroid injections led to fungal infection and fewer than one in 150,000 injections led to a fatal fungal infection.

As with all medicines, the possibility for contamination exists. Because of the area in which steroid injections are administered epidural steroid injection side effects due to this can be more serious. Read on to learn strategies for avoiding this risk.

4. Risk of bone fracture increases

Especially in vulnerable populations, the risk of spinal bone fracture increases by 29% with each steroid injection. Shlomo Mandel, M.D., a Henry Ford orthopedic physician and the study’s lead author (and author of the more recent study on postmenopausal women) believes that serious epidural steroid injection side effects must be discussed, noting:

“For a patient population already at risk for bone fractures, steroid injections carry a greater risk than previously thought and actually pose a hazard to the bone.”

When are epidural steroid injections the right treatment?

While there are risks, the evidence is also clear that epidural steroid injections can provide short-term benefits (lasting several months) for many patients that include reduced pain, and the ability to return to work and resume normal life. The long-term benefits, over the course of years, appear to be smaller but some patients continue to find relief and are able to avoid more extreme treatments because of these injections.

Epidural steroid injections are most useful for certain types of back pain. Some patients’ back pain is the result of one or more bulging spinal discs. When the disc protrudes to the side, it can put pressure on the nerve roots that pass through the spine. Often, this occurs in the lower back and causes pain that radiates from the lower back down the legs. This is often called sciatica or lumbar radiculitis. The research is clear that epidural steroid injections can help reduce pain for such patients, in part because these injections reduce the inflammation, relieving pressure on the nerve roots.

Learn more about how these treatment is performed in the epidural steroid injection video below.

How to prevent epidural steroid injection side effects

With the potential for such serious side effects, it might be easy to dismiss steroid injections as a pain management option. However, steroid injections can be a very effective way to manage debilitating pain. Here are five ways to prevent or avoid side effects of epidural steroid injections.

1. Work with a highly-skilled, experienced pain management specialist

For such a delicate procedure, you want a pain doctor who is skilled and experienced in steroid injections. Ask friends and family for referrals if they have experience in this area. You can also search the licensing boards of your state to see if your pain management specialist has been commended (or censured). Using a locator tool online can help.

2. Understand your level of risk

Certain groups are more vulnerable to serious side effects of steroid injections. Postmenopausal women who are already experiencing bone loss may not want to receive steroid injections. Other risk factors for serious side effects include:

  • Underlying health conditions
  • Compromised immune system
  • Smoking or alcohol consumption
  • Overall health

3. Know what location of injection works best

There are three locations or types of steroid injection: transforaminal, interlaminar, and caudal. Caudal injections allow the most medicine to flood the entire spinal column but are often associated with the most serious side effects. Of the three, caudal injections also seem to offer the least pain relief in both the short- and long-term. Talk to your doctor about the type of injection she or he is proposing.

4. Do your research and ask questions

One of the best ways to minimize steroid injection side effects is to do your research and ask your doctor questions about the procedure. There is a lot of conflicting research on steroids. A comprehensive review of the studies can help you learn more about this treatment.

Also, you must be actively involved in decisions about the care you receive. A patients’ ability to make informed choices depends on their understanding of their condition and the treatment options available. You can find out more about epidural steroid injections and news about them by subscribing to the blog on PainDoctor.com or reading through our posts on this topic.

5. Reduce your risk factors

As much as possible, take steps to reduce the factors that put you at risk for more serious side effects. Quit smoking, begin exercising as you can, and eat healthy. It can be difficult to make these changes when struggling with back pain. Exercise can be especially challenging. Work with a physical therapist to design a program of exercises that can be completed while seated to get yourself in the best shape possible.

14 Epidural Steroid Injection Side Effects (And How To Avoid Them) | PainDoctor.com

Other pain management options

Like any tool, once it is found useful there is a risk that it will be overused. Responsible pain doctors rely on many tools for comprehensive pain management, of which epidural steroid injections are just one. The best pain doctors will first pursue conservative care for their patients. This means:

  • Acupuncture
  • Chiropractic care
  • Physical therapy
  • Behavioral therapy
  • Holistic treatments
  • Over-the-counter medications

If those treatments are not successful in alleviating your pain, your pain doctor should then move on to low risk medications, such as non-steroidal anti-inflammatory and neuropathic medications. If your symptoms are still not controlled by these treatments, the remaining options include:

  • Surgery
  • Opioids
  • Injection treatments, such as epidural steroid injections

Unfortunately, these more interventional treatments all carry risks. This is why these treatments are used only for patients who continue to suffer from moderate to severe pain even after conservative care. Many surgical treatments have much greater risks and side effects than injection therapy. Opioids not only carry a significant risk of addiction, but also cause over 16,500 deaths each year. When epidural steroid injections are compared to the risks of surgery or the use of opioids, the potential risks and benefits can be well-justified.

Finding a balanced approach

Not every patient in pain needs an epidural steroid injection, but the right patient will likely benefit from its effects. When it comes down to it, you may decide that the side effects of steroid injections just aren’t worth risking for your particular case.

While some people find immediate, long-lasting relief from this type of pain management, if you are worried about epidural steroid injection side effects and not convinced they will work, choosing another pain management strategy is okay. You have the final say in the treatment of your pain. Pain management specialists have a number of different options for treating pain. A caring and compassionate doctor will work with you to find a pain management strategy that works for you.

If you have tried steroid injections, did you experience any side effects? Did the injections work? If you’re interested in learning more about this treatment approach, click the button below to talk to a pain doctor in your area about how they could work for you. 

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Learn more about epidural steroid injections: 

Epidural Steroid Injections 101

15 Frequently Asked Questions About Epidural Steroid Injections

How Can Epidural Steroid Injections Help My Back Pain?

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By | 2017-07-31T18:34:01+00:00 July 15th, 2017|Tags: , |17 Comments

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Pain Doctor
Pain Doctor was created with one mission in mind: help and educate people about their pain conditions, treatment options and find a doctor who can help end their pain issues.

17 Comments

  1. Robert Greenbaum August 2, 2017 at 11:32 am - Reply

    Very well written article. Yesterday I had an epidural (most likely in the L5 area) and asked the neurologist to make sure that the steroid contacted the area producing stenosis symptoms in the upper legs (L3-L4). During the procedure I believe the needle was guide upward and felt the injection effect “penetrating” my upper legs. Today I can barely walk without extreme pain in the upper legs. I am hopeful that by tomorrow the pain will subside and the steroid will begin to alleviate my current and prior pain symptoms. I would be happy to report my condition tomorrow if you contact me.

    • Pain Doctor
      Pain Doctor August 6, 2017 at 2:56 pm - Reply

      Hi Robert — We definitely recommend reaching out to your doctor and discussing your side effects.

  2. Ademola Abdulrahm August 25, 2017 at 3:11 am - Reply

    Comment…
    I just had an operation, changing my ball and socket joint from the right leg (L4). But right now, am really experiencing severe headache, when I complained to my doctor and he said it will go with time. I still feel the pain, I will be glad if you can suggest any remedy to hasten my recovery… Thanks in anticipation.

    • Pain Doctor
      Pain Doctor August 28, 2017 at 12:54 pm - Reply

      Hi Ademola — Unfortunately we can’t offer specific medical advice on the blog. We recommend following up with your doctor or reaching out to someone for a second opinion. Hope that helps.

  3. Aurora Arcilla September 4, 2017 at 8:27 pm - Reply

    I had epidural injection last July and I am now experiencing elevated blood pressure and blood sugar. Is this side effect of the injection? I need your advice what to do to minimize the side effects. Thank you

    • Pain Doctor
      Pain Doctor September 10, 2017 at 7:46 pm - Reply

      Hi Aurora — Unfortunately we can’t offer specific medical advice on the blog. We recommend following up with your doctor or reaching out to someone for a second opinion. Hope that helps.

    • b September 15, 2017 at 8:12 am - Reply

      My aunt has experienced the same thing. How was your issue resolved?

  4. Rhonda September 21, 2017 at 12:50 am - Reply

    My experience with steroid epidurals for several herniated discs in my lower back was great! The pain before the shots was so intense that I could barely function for a couple of months. Immediately after the first round of injections I didn’t feel any difference. About a week later I felt wonderful relief! I was about 80% pain free and I was happy! I’ve since had 3 more series of shots and I ended up being pain free for a while after my second series. Eventually I needed another round of shots but I never got anywhere near as bad as I was from the beginning. After my 3rd set of shots, the effectiveness started to decrease. I currently have had my 4th series (in a little over a years time span) & I’m about 90% pain free.
    The only side effects that I experienced was a slight headache the night of each of the injections and slight weight gain. I haven’t gained anything significant, maybe 10-15 lbs, but I’ll take the weight gain over that amount of pain anyday. Definitely a
    success for me!

    • Pain Doctor
      Pain Doctor September 23, 2017 at 1:50 pm - Reply

      Thanks for sharing your story here Rhonda! We’re so glad they helped your pain!

  5. Cheswin October 7, 2017 at 10:02 pm - Reply

    I need help please. I had a epidural injection done on Friday, 6 October 2017. After the procedure I have been experiencing severe muscle contractions from the centre of my back straight to my neck and resulting to severe head ache. This only happens when I stand up from a laying position. Its like as soon as I am in a vertical position these muscles all rapidly contract and pulls stiff. Its been 2days after the procedure and still no change

    • Pain Doctor
      Pain Doctor October 9, 2017 at 5:43 pm - Reply

      Hi Cheswin — Unfortunately we can’t offer specific medical advice on the blog. We recommend following up with your doctor or reaching out to another local specialist for a second opinion. Hope that helps.

  6. Lea October 23, 2017 at 4:57 am - Reply

    I had a a ESI on October 19th 2017 for pain from a radial tear at L4 and L5. This was from an on the job injury from back in May 2017.
    Immediately after the procedure I was in excruciating pain and had to limp to a chair near the checkout desk. I felt nauseated, dizzy, tingling and twitching in my left cheek, palpations and shaking all over.
    5 days later, I am still feeling awful. I had to ask for the next two days off of work.
    I have a worse headache than normal, like an ice pick is stuck in my head. I feel very shaky still, like I have had way too much caffeine. Worse back pain than before the shot. I have had flushing in my face and neck, I looked and felt like I had a bad sunburn. My vision is blurry and I just feel terrible. My back pain was bad enough as it was and now it’s worse and all of these other things! I wish I had never had that injection and will never have another. I know that some people find relief with them and maybe I will in the days or weeks to come. However, I think that this is mostly a way to make Doctors and Big Pharma lots of money!
    I wish everyone the best with their pain management.
    Do your homework before you get one of these. I did some but I am finding other disturbing potential side effects that I did not come across before the injection.
    Most Doctors don’t seem to tell you about these things.

    • Pain Doctor
      Pain Doctor October 23, 2017 at 4:55 pm - Reply

      Thank you for sharing your story Lea. As you said, some people don’t get relief from these injections but they are cost-saving and effective options for many patients–especially those who would otherwise be considering surgery. It’s great to hear from a number of different patients though and their experiences.

  7. Tim October 25, 2017 at 6:15 pm - Reply

    I had epidural injection and now my ankle where I had surgery feels weird like there’s something floating !! Does the injection effect other parts of your body ??

  8. Kristine November 3, 2017 at 11:26 am - Reply

    Had a Cervical Epidural steroid injection on Oct 19th. I immediate stomach blotting. Now since the procedure having chronic diarrhea. Nothing seems to help. I even went back on a natural probiotic which had used years ago. My pain clinic dr doesn’t agree the chronic diarrhea is from the injection but it clearly shows in the side effects that it can be a side effect. Have taken OTC anti diarrhea meds and it’s not helping.

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