The efficacy of an epidural depends on many factors, including but not limited to:

The injection may sometimes be used in combination with a comprehensive rehabilitation program to increase the likelihood of longer-term pain relief and return to everyday activities.⁶Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review. Clin Orthop Relat Res. 2015;473(6):1940–1956. doi:10.1007/s11999-014-3490-4

Other factors that may affect the outcome of this treatment include the physician’s skill and experience in administering the injection, the use of guided fluoroscopy, and the patient’s general health. The treatment may also be more effective in treating acute pain (versus chronic symptoms).

The success rates of epidural steroid injections for the treatment of a few common conditions are discussed below.

Sciatica, which is medically known as lumbar radiculopathy, is nerve pain that originates deep in the buttock and travels down to the thigh and/or leg. Sciatica is commonly caused when a herniated disc or narrowing of the bony opening for spinal nerves (foraminal spinal stenosis) compresses a nerve root in the lumbar spine.¹Patel K, Upadhyayula S. Epidural Steroid Injections. [Updated 2019 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470189/

Clinical trial results in the treatment of sciatica pain with epidural steroid injections have the following success rates:

Other conditions such as spinal cysts or ligament thickening that cause spinal nerve compression and radicular nerve pain in the legs may also yield similar results when treated with these injections.

Localized lower back pain is typically caused due to inflammatory changes within the spinal soft tissues or lumbar discs.³Pandey RA. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes. J Clin Diagn Res. 2016;10(7):RC05–RC11. doi:10.7860/JCDR/2016/18208.8127^,10Chang, Douglas, Zlomislic, Vinko. Chapter 273. Lumbar Spinal Injections. In: Chapman, Michael W. Chapman's Orthopaedic Surgery. Philadelphia: Lippincott Williams & Wilkins. https://www.researchgate.net/publication/327034223_Lumbar_spinal_injections_Chapman's_Orthopaedic_Surgery_Chapter_273. Accessed June 26, 2019.^,11Fujii K, Yamazaki M, Kang JD, et al. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus. 2019;3(5):e10180. Published 2019 Mar 4. doi:10.1002/jbm4.10180

In a study involving 120 participants with axial low back pain, treatment with 4 injections given over a span of 1 year showed more than 50% improvement in pain and functional outcome in 68% of patients.¹²Manchikanti L, Pampati V, Benyamin RM, Boswell MV. Analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial discogenic pain: local anesthetic alone vs. local combined with steroids. Int J Med Sci. 2015;12(3):214–222. Published 2015 Jan 20. doi:10.7150/ijms.10870 Other studies have reported pain relief for 2 years when 6 injections were spaced out and given during this period.¹³Manchikanti L, Cash, McManus, Pampati. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain. Journal of Pain Research. October 2012:381. doi:10.2147/jpr.s35924

Neurogenic claudication, characterized by pain felt in both legs while walking variable distances, is usually treated with bilateral transforaminal epidural steroid injections (given on both sides of the spine).

A study involving 22 participants showed 30% of patients experiencing pain relief at 1 month, 53% at 3 months, and 44% at 6 months after receiving bilateral injections.¹⁴Farooque M, Salzman MM, Ye Z. Effectiveness of Bilateral Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spinal Stenosis Patients With Neurogenic Claudication: A Case Series. PM&R. 2016;9(1):26-31. doi:10.1016/j.pmrj.2016.06.002 Other studies have reported pain relief for 2 years when 6 injections were spaced out and given during this period.⁴Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis; A Systematic Review. Anesthesiology and Pain Medicine. 2015;5(1).

Research indicates that an additional injection may be given if the following criteria are met³Pandey RA. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes. J Clin Diagn Res. 2016;10(7):RC05–RC11. doi:10.7860/JCDR/2016/18208.8127:

Common guidelines recommend that if more than 4 epidural steroid injections are needed in 1 year, the underlying condition must be managed by other treatment methods.³Pandey RA. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes. J Clin Diagn Res. 2016;10(7):RC05–RC11. doi:10.7860/JCDR/2016/18208.8127

To improve the overall outcome of the procedure and reduce the risk of side effects, using a blunt needle, live fluoroscopy, and administering a small test dose initially may be helpful.¹⁵Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV. Safety of Epidural Corticosteroid Injections. Drugs R D. 2016;16(1):19–34. doi:10.1007/s40268-015-0119-3

A guided physical therapy program may be combined with the epidural steroid injection treatment for an added benefit. Studies suggest that combining physical therapy with the injection treatment of herniated discs may improve the quality of pain relief and overall satisfaction in the patient.¹⁶van Helvoirt H, Apeldoorn AT, Ostelo RW, et al. Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation. Pain Medicine. 2014;15(7):1100-1108. doi:10.1111/pme.12450 Injection treatment of lower back conditions such as lumbar spinal stenosis may benefit from improved quality of life and overall health when combined with physical therapy; with no direct effect on pain-relief values.¹⁷Hammerich A, Whitman J, Mintken P, et al. Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial. Archives of Physical Medicine and Rehabilitation. 2019;100(5):797-810. doi:10.1016/j.apmr.2018.12.035^,18Akuthota V, Hammerich AS, Mintken PE, et al. Effectiveness of Physical Therapy as an Adjunct to Epidural Steroid Injections in the Treatment of Lumbar Spinal Stenosis: A Pilot Randomized Controlled Trial. The Spine Journal. 2012;12(9):S146. doi:10.1016/j.spinee.2012.08.379

See Physical Therapy and Exercise for Sciatica

• Sciatica Treatment
• Epidural Steroid Injections for Back Pain and Leg Pain Video
• Cervical Epidural Steroid Injection Video
• Cervical Selective Nerve Root Block Video