Pain that travels from your neck into your arm or from your lower back into your leg may be caused by an irritated or inflamed spinal nerve. An epidural steroid injection, or ESI, is a minimally invasive procedure that delivers anti-inflammatory medication near the affected nerve root to help reduce inflammation and radiating pain.
Epidural steroid injections may be considered for conditions such as herniated discs, sciatica and radiculopathy, and other causes of spinal pain. They may also be considered for some patients with back pain or neck pain when nerve irritation is contributing to their symptoms.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, imaging, and treatment history to determine whether an epidural steroid injection or another treatment may be appropriate for you.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is an Epidural Steroid Injection?
An epidural steroid injection is a minimally invasive procedure used to place corticosteroid medication into the epidural space of the spine. This is the area outside the protective covering surrounding the spinal cord and spinal nerve roots.
When a spinal nerve becomes irritated or inflamed, pain may travel away from the spine and into an arm or leg. Patients may also experience numbness, tingling, burning, or other nerve-related symptoms.
The corticosteroid medication is intended to reduce inflammation around the affected nerve. A local anesthetic may also be used during the procedure.
An epidural steroid injection does not remove a herniated disc, enlarge a narrowed spinal canal, or cure the underlying condition. Instead, it may provide temporary symptom relief while the underlying condition is managed through a broader treatment plan.
Epidural steroid injections used for pain management are also different from the epidural anesthesia commonly associated with childbirth or surgery.
Who May Be a Candidate for an Epidural Steroid Injection?
Your pain management provider may consider an epidural steroid injection when your symptoms suggest that a spinal nerve root is irritated or inflamed.
You may be evaluated for an ESI if you have:
- Pain that radiates from the lower back into the buttock, leg, or foot
- Pain that travels from the neck into the shoulder, arm, or hand
- Numbness or tingling associated with an irritated spinal nerve
- Symptoms of sciatica or radiculopathy
- Persistent symptoms that have not improved enough with conservative treatment
- Imaging findings that correspond with your symptoms and physical examination
An epidural steroid injection is not appropriate for every type of back or neck pain. For example, pain originating primarily from the facet joints may be evaluated with treatments such as facet joint injections or a medial branch block instead.
Your provider will review your medical history, symptoms, examination findings, imaging, previous treatments, medications, and treatment goals before recommending an injection.
What Conditions Can Epidural Steroid Injections Help Treat?
Epidural steroid injections are most commonly considered when inflammation or irritation of a spinal nerve contributes to radiating pain.
Conditions that may lead to these symptoms include:
Disc Herniation
A herniated or bulging disc can irritate or place pressure on a nearby spinal nerve. Depending on the location of the affected disc, symptoms may radiate into an arm or leg.
Sciatica and Radiculopathy
Sciatica and radiculopathy occur when a spinal nerve root becomes irritated or compressed. Symptoms may include shooting or burning pain, numbness, tingling, or weakness along the path of the affected nerve.
Spinal Stenosis
Spinal stenosis is a narrowing of spaces within the spine that may contribute to irritation or compression of nearby nerves. When nerve involvement causes radiating symptoms, an epidural steroid injection may be one treatment option considered.
Degenerative Spine Changes
Age-related changes involving spinal discs and surrounding structures can sometimes contribute to nerve-root irritation. Treatment depends on the specific structure causing the symptoms rather than the presence of degeneration alone.
Pain After Spine Surgery
Some patients continue to experience nerve-related pain after previous spine surgery. In selected cases, an epidural injection may be considered as part of a broader evaluation and treatment plan.
Because many different conditions can cause spinal pain, identifying the likely source of your symptoms is an important part of determining whether an epidural steroid injection is appropriate.
Types of Epidural Steroid Injections
There are several ways medication can be delivered into the epidural space. The appropriate approach depends on factors such as the location of your symptoms, spinal anatomy, imaging findings, and the nerve or nerves believed to be involved.
Common approaches include:
Interlaminar Epidural Injection
With an interlaminar approach, medication is introduced into the epidural space between the vertebrae. This allows medication to spread within the epidural space around nearby spinal nerves.
Transforaminal Epidural Injection
A transforaminal epidural injection targets the area where an individual spinal nerve exits the spine. This approach may be considered when symptoms appear to originate from a specific nerve root.
A selective nerve root block is another targeted procedure that may be used when a particular nerve is suspected of causing symptoms.
Caudal Epidural Injection
A caudal epidural injection enters the epidural space through an opening near the lower end of the spine. Medication can then travel upward within the epidural space.
Not every approach is appropriate for every patient. Your provider will determine whether an epidural injection is recommended and which technique is most appropriate for your condition.
How Does an Epidural Steroid Injection Work?
Before the procedure begins, you will be positioned so your provider can safely access the appropriate area of the spine. The skin is cleaned, and a local anesthetic is generally used to numb the injection site.
Your physician then uses fluoroscopy, a form of real-time X-ray guidance, to help guide the needle toward the intended location. Contrast material may be used when appropriate to help confirm needle placement before medication is administered.
The medication typically includes a corticosteroid intended to reduce inflammation. A local anesthetic may also be included.
After the injection, the needle is removed and you will be monitored for a period of time before leaving.
The injection itself is generally a brief procedure, although your total time at the facility will be longer because of preparation, monitoring, and discharge instructions.
What to Expect Before, During, and After an Epidural Steroid Injection
Before the Procedure
Your care team will provide instructions based on your health history and the specific procedure being performed.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have diabetes
- Have an active infection, fever, or illness
- Have allergies to medications, contrast material, or other substances
- Are pregnant or may be pregnant
- Have experienced a previous reaction to an injection or corticosteroid medication
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow any instructions provided by the office regarding eating, drinking, medications, and transportation. Patients should generally arrange transportation following the procedure unless instructed otherwise by the clinical team.
If you are preparing for an upcoming visit, our patient forms are also available online.
During the Procedure
You may feel a brief pinch or burning sensation when the local anesthetic is administered. During needle positioning or injection, some patients notice pressure, tingling, or temporary discomfort.
Fluoroscopic imaging allows the physician to view the relevant spinal anatomy while guiding the needle.
If you experience intense or unusual pain during the procedure, tell your physician immediately.
After the Procedure
Some soreness around the injection site is common. Your usual pain may also temporarily increase before the corticosteroid begins to have an effect.
Your care team will provide specific instructions regarding activity, medications, driving, and when you can return to your usual routine. Patients are commonly advised to avoid strenuous activity for the remainder of the procedure day.
Contact the office if you develop symptoms that concern you after your injection. Seek urgent medical attention for severe or rapidly worsening symptoms such as significant new weakness, loss of bowel or bladder control, severe headache accompanied by neurologic symptoms, difficulty breathing, or other symptoms identified in your discharge instructions.
Risks, Side Effects, and Safety Considerations
Epidural steroid injections are commonly performed in pain management, but every medical procedure involves potential risks and side effects.
Temporary effects may include:
- Soreness or bruising at the injection site
- A temporary increase in pain
- Headache
- Flushing
- Dizziness
- Temporary numbness or weakness
- Temporary changes in blood sugar, particularly in patients with diabetes
- Other effects related to corticosteroid medication
Less common complications can include:
- Bleeding
- Infection
- Allergic reaction
- Dural puncture and spinal headache
- Nerve injury
- Complications related to medications or contrast material
Rare but serious neurologic complications have also been reported following epidural corticosteroid injections.
Corticosteroids are commonly used in epidural injections for pain management, but corticosteroid medications are not specifically FDA-approved for administration into the epidural space. Your physician can discuss the potential benefits, limitations, and risks of the procedure as they relate to your individual condition.
Your medical history, medications, spinal anatomy, and overall health are considered when determining whether an epidural steroid injection is an appropriate option.
How Soon Does an Epidural Steroid Injection Work?
Results vary from patient to patient.
If a local anesthetic is used, you may notice temporary changes in your symptoms shortly after the procedure. This initial effect is different from the effect of the corticosteroid medication.
The corticosteroid generally takes more time to work. Some patients begin noticing improvement within several days, while others may take longer.
It is also possible for symptoms to temporarily increase for a short period before improving.
An epidural steroid injection does not provide meaningful relief for every patient. Your response to the procedure can help your physician determine what should come next in your treatment plan.
How Long Can Relief Last?
The duration of relief following an epidural steroid injection varies considerably.
Some patients experience improvement for several weeks or months, while others experience shorter relief or little change in their symptoms. The response may depend on factors such as:
- The underlying cause of the nerve irritation
- How long symptoms have been present
- The severity of the condition
- The location of the affected nerve
- The injection approach
- Other medical conditions
- Your response to previous treatment
The purpose of an epidural steroid injection is generally not to permanently cure the underlying spinal condition. Temporary reduction in symptoms may allow some patients to participate more comfortably in physical therapy, exercise, rehabilitation, work, or daily activities.
How Many Epidural Steroid Injections Can You Have?
There is no automatic number of epidural steroid injections that every patient should receive.
Some patients may receive one injection and not require another. In other cases, a repeat injection may be considered depending on the amount and duration of relief, improvement in function, diagnosis, overall treatment plan, and potential risks of additional corticosteroid exposure.
Epidural steroid injections should not automatically be scheduled as a predetermined series.
If an injection does not provide the expected benefit, your provider may recommend reassessing the cause of your symptoms rather than simply continuing the same treatment.
Insurance plans may also have specific requirements regarding repeat injections.
What Happens If an Epidural Steroid Injection Does Not Work?
Not responding to an epidural steroid injection does not mean that there are no other treatment options.
If you do not experience meaningful improvement, your provider may reconsider the source of your pain and review your examination findings, imaging, and response to previous treatment.
Depending on your condition, the next step could include:
- Physical therapy or rehabilitation
- Changes to medications
- Additional diagnostic testing or imaging review
- A different type or approach to injection
- A more targeted selective nerve root block
- Facet joint injections if the suspected pain source is different
- A diagnostic medial branch block followed by radiofrequency ablation when facet-mediated pain is identified
- Other interventional pain management options
- Referral for surgical evaluation when clinically appropriate
Pain can come from discs, nerves, joints, muscles, and other structures. Our goal is to identify the likely pain generator and recommend treatment based on your individual diagnosis rather than relying on one procedure for every type of pain.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to epidural steroid injections includes:
- Individualized evaluation before recommending a procedure
- Fluoroscopic image guidance
- Treatment based on the suspected source of pain
- Non-surgical and minimally invasive options when appropriate
- Access to additional pain management treatments when an epidural injection is not the right option
- Care focused on improving function and quality of life rather than promising a specific outcome
Epidural Steroid Injection Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists serves patients throughout metro Atlanta through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Epidural Steroid Injections
An epidural steroid injection places corticosteroid medication into the epidural space near spinal nerves. The goal is to reduce inflammation around an irritated nerve root and potentially decrease radiating pain, numbness, tingling, or other nerve-related symptoms.
Epidural steroid injections may be considered for nerve-related symptoms associated with conditions such as disc herniation, sciatica or radiculopathy, spinal stenosis, and other conditions that irritate spinal nerve roots. Your provider will determine whether your symptoms and examination findings make an ESI an appropriate treatment option.
No. Both involve the epidural space, but they are performed for different reasons and use different treatment approaches. An epidural steroid injection is used in pain management to place anti-inflammatory medication near irritated spinal nerves.
Patients may feel a brief pinch or burning sensation when local anesthetic is administered. You may also notice pressure, tingling, or temporary discomfort during the procedure. Experiences vary, and you should tell your physician if you experience intense or unusual pain.
The injection itself is generally brief. Your total appointment will take longer because of preparation, positioning, the procedure, and monitoring afterward. Your care team can give you more specific instructions before your appointment.
The corticosteroid does not always work immediately. Some patients begin noticing improvement within a few days, while others may take longer. Symptoms can also temporarily increase before the medication begins to have an effect.
Relief varies considerably between patients. Some people experience improvement lasting weeks or months, while others receive limited or no relief. The underlying condition and your individual response to treatment influence how long any benefit lasts.
There is no predetermined number that is appropriate for every patient. Whether another injection is recommended depends on your response to the first procedure, improvement in function, diagnosis, overall health, and treatment plan.
Potential effects include temporary soreness, increased pain, headache, flushing, dizziness, numbness, weakness, or changes in blood sugar. Less common complications include bleeding, infection, allergic reaction, dural puncture, and nerve injury. Rare serious neurologic complications have also been reported. Your physician will discuss risks that are relevant to your health and procedure.
Follow the transportation instructions provided by your care team. Patients are generally advised to arrange transportation after an epidural steroid injection unless the clinical team tells them otherwise.
Your provider may reassess the likely source of your pain, review your imaging, adjust your treatment plan, or consider other therapies. Depending on the diagnosis, options may include physical therapy, medication changes, another type of targeted injection, other interventional procedures, or surgical evaluation when appropriate.
Regenerative Spine and Pain Specialists serves patients through offices in Fayetteville, Marietta, and Atlanta, Georgia. The location of your evaluation, follow-up visit, or procedure may vary. Our scheduling team will confirm the appropriate location when arranging your care.
Schedule an Appointment for Epidural Steroid Injection Evaluation
Radiating neck, back, arm, or leg pain can interfere with work, sleep, exercise, and everyday activities. If your symptoms may be related to an irritated spinal nerve, an epidural steroid injection may be one option to consider.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, review your previous treatment and imaging when appropriate, and help determine whether an epidural steroid injection or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.
Epidural steroid injections are commonly used to relieve pain associated with:
Herniated or bulging discs
Sciatica (radiating leg pain)
Spinal stenosis (narrowing of the spinal canal)
Degenerative disc disease
Facet joint arthritis
Diabetic peripheral neuropathy
Post-laminectomy syndrome
Tendinitis or bursitis (hip/knee)
These injections target spinal nerve inflammation, making them highly effective for patients with nerve-related pain.
The procedure involves:
Cleaning and numbing the injection site with a local anesthetic.
Using fluoroscopy (X-ray guidance) to accurately guide the needle into the epidural space.
Injecting a combination of corticosteroid and local anesthetic medication to reduce inflammation.
The entire process usually takes less than 30 minutes, and patients can return home the same day.
Pain relief can begin within a few days and may last several weeks to months. For chronic conditions, your doctor may recommend a series of up to three injections spaced weeks apart. Some patients experience lasting relief after only one injection.
Yes—when performed by trained specialists, ESIs are safe and low-risk. Our providers use image guidance and sterile technique to minimize complications. Some temporary side effects may include soreness at the injection site or mild dizziness.
Before:
Wear loose, comfortable clothing.
Arrange transportation, as driving is not recommended post-procedure.
Notify us if you are taking blood thinners or have an active infection.
After:
You may feel some soreness for a day or two.
Limit strenuous activity for 24 hours.
Pain relief typically starts within 2–5 days.
Our fellowship-trained physicians offer:
Fluoroscopy-guided precision
Tailored treatment plans for each patient
Locations in Atlanta, Marietta, and Fayetteville, GA for easy access
Advanced pain management options beyond injections
If you’re experiencing ongoing back, neck, or leg pain, epidural steroid injections may help you regain your quality of life. Call 404-618-0995 to schedule your consultation with Dr. Zwade Marshall, or Dr. Jennifer Xiong today.