You had an epidural steroid injection for back and leg pain, or neck and arm pain, and now you want to know how long the relief will last. Maybe it worked within hours and you are wondering when it will stop. Maybe it has not worked yet and you are wondering if it failed.
The short version: the numbing medicine wears off within hours, the steroid usually starts working within a few days, and the relief it brings often lasts weeks to several months. How long it lasts for you depends mostly on what is causing the pain and what you do while it is calmer.
Quick answer: how long does an epidural steroid injection last?
Relief from an epidural steroid injection commonly lasts from a few weeks to several months, and for some people longer. The North American Spine Society says the improvement in pain and function often lasts several months or longer. Some people get little or no relief at all, and there is no reliable way to know in advance which group you will be in.
Two things make the biggest difference:
- The kind of pain. These injections treat inflammation around a spinal nerve, so they are aimed at pain that travels down a leg or an arm. Back or neck pain without that pattern is a less clear target.
- What you do with the window. An injection is meant to calm the pain enough for you to move, strengthen and do physical therapy. It does not fix the disc or the narrowing that irritated the nerve in the first place.
Two clocks: what you feel in the first hours and the first week
Many epidural steroid injections contain two medicines, and they work on very different timelines. Knowing which one you are feeling explains most of the worry in the first few days.
The first few hours: the numbing medicine
A local anesthetic is often added to the steroid. It can ease the pain almost right away, sometimes before you leave the office. That early relief is the numbing medicine, and it wears off within hours. When it does, your usual pain can come back. That does not mean the injection failed.
The first few days to a week: the steroid
The steroid is the part meant to last. According to the North American Spine Society, it usually begins working within 1 to 3 days, and in some cases it takes up to a week to feel the benefit. Judge the injection after that first week, not on the day after.
A flare before it settles
Some people notice their usual pain is worse for several days after the procedure. It is uncommon, and it usually settles. Mild steroid side effects, such as a flushed face, trouble sleeping or feeling anxious, can also show up and usually pass within a few days.
What decides how long your relief lasts
Doctors cannot promise a number of weeks, but a few things tend to make a difference.
What is pressing on the nerve
A herniated disc, where the soft center of a disc pushes out against a nerve, often shrinks and settles over time. If the injection calms the nerve while that happens, the relief can feel permanent, because the cause is fading underneath it. Narrowing of the spinal canal from spinal stenosis works differently. It usually comes from gradual wear in the spine and tends not to reverse on its own, so relief is more likely to wear off and the pain to come back.
Where the pain is
Epidural injections are used for low back related leg pain and neck related arm pain, the kind of pain that follows a nerve. If your pain stays in the back or neck, it may be coming from somewhere else, such as the small facet joints, and a different injection may suit it better.
What you do while the pain is lower
The relief is a window. Injections are commonly paired with physical therapy for a reason: using the calmer weeks to build strength and movement gives your spine a better chance of staying calm after the steroid fades. Waiting for the injection to do all the work means the pain is more likely to return as the medicine wears off.
Is an injection just masking the problem?
It is a fair worry. An epidural steroid injection does not repair a disc or widen a narrow canal. What it does is reduce the inflammation around an irritated nerve so the pain comes down, which lets you move, sleep and do rehabilitation.
For many people that is enough, because the underlying problem settles with time or with therapy. For others it buys time to make a decision without being in constant pain. What it should not do is hide signs of real nerve damage. New weakness or numbness is a reason to be examined, whatever the injection is doing for the pain.
Can you repeat an epidural steroid injection?
Yes. If an injection helped a lot, it can be repeated to keep the improvement going. Some people get partial relief from the first one, and a second, sometimes given at a different level or by a different approach, helps more.
There is a limit. Steroids given too often or in higher doses may weaken the bones of the spine or nearby muscles, so doctors limit how many you receive, commonly to about three a year. Your doctor will space them out and look at how long each one helped before recommending another.
If each injection helps for a shorter time than the last, or you are relying on them just to get through daily life, that pattern is a signal to look harder at the cause rather than keep treating the pain.
When it wears off or does not help: what comes next
An injection that did not help, or one whose relief keeps getting shorter, still tells your doctor something. The next step depends on what the exam and your imaging show.
A different injection for a different source
If the pain is coming from the facet joints rather than a nerve root, a medial branch block can test that and guide treatment. Pain from the joint where the spine meets the pelvis may respond to a sacroiliac joint injection.
A closer look at the disc
If an MRI shows a disc pressing on a nerve, such as a lumbar herniated disc or a cervical herniated disc, the question becomes whether it is improving with time and therapy or not.
A surgical opinion
When leg or arm pain keeps coming back after injections and therapy, or there is weakness, a spine surgeon can look at whether a procedure to take pressure off the nerve makes sense. Our post on sciatica surgery covers when that point is reached and what recovery looks like.
Signs that should not wait
Go to an emergency room if you have new numbness in the groin or inner thighs, new trouble controlling your bladder or bowels, or weakness in your legs that is getting worse. These can be signs of serious pressure on the nerves at the bottom of the spine.
After an injection, call your care team promptly if you develop a fever, a severe headache, or redness, swelling or drainage where the needle went in.
Your next step
If you have had an injection that wore off, or you are trying to decide whether one is worth it, the most useful thing is a clear answer about what is causing your pain. Mountain Spine & Orthopedics offers a complimentary MRI review and second opinion, and our team includes spine surgeons and a pain management physician, so injections and surgery are weighed in the same conversation. You can read more about the procedure itself on our epidural steroid injection page.
Frequently Asked Questions
Answers to the most common patient questions about this topic.
How long does it take for an epidural steroid injection to work?
The numbing medicine can ease pain within minutes, but it wears off within hours. The steroid usually starts working within 1 to 3 days, and sometimes it takes up to a week. Judge the result after the first week.
How long does an epidural steroid injection last?
Relief commonly lasts from a few weeks to several months, and longer for some people. Others get little or no relief. It tends to be aimed at pain that travels down a leg or an arm from an irritated nerve.
How often can you get an epidural steroid injection?
If an injection helps, it can be repeated. Because steroids given too often may weaken the bones of the spine or nearby muscles, doctors limit how many you receive, commonly to about three a year.
Can you drive after an epidural steroid injection?
Plan for someone else to drive you home on the day of the injection.
How soon can you exercise after an epidural steroid injection?
Most people can return to their usual level of activity the day after the injection. Ease back in, and use the period of lower pain to start or continue physical therapy, which is what the injection is meant to make possible.
Can you eat, drink or take your usual medicines before an epidural steroid injection?
Follow the instructions your care team gives you, since fasting rules usually depend on whether you will have sedation. Tell the team about every medicine you take, especially blood thinners, and do not stop any medicine without your prescribing doctor's advice.
