Epidural for back pain

Your consultant may recommend an epidural for back pain if you have one of the following conditions.

Herniated disc

A herniated disc (also known as a slipped disc) happens when the soft jelly-like centre of the cushions (discs) that sit between your spinal bones (vertebra) pushes out due to a tear in the rubbery exterior of your disc, which can occur when you do an activity that involves twisting at high speed. A slipped disc usually shows up in your lower back, leading to a compression of your nerves against your spinal canal due to the damage caused to the cushions that support your spine's shape. You may experience pain and numbness as a result.

Spinal stenosis

Spinal stenosis is a condition that develops gradually over time, leading to the narrowing of one or more spaces in your lower spine. When there is less space within your spine, there is less available space for your nerve roots to travel, which means your nerves could possibly become irritated, giving you pain in your lower back - especially when you're walking.

Lumbar osteoarthritis

Lumbar osteoarthritis is a common form of arthritis that causes the protective tissue that covers your joints to gradually wear down. Your bones and discs in your spine eventually change in shape, meaning that the interior of your spinal column or the opening where your spinal exit can reduce in size, which in turn makes it more likely for your nerves to become compressed and inflamed.

Bone spurs

Bone spurs (or osteophytes) are bony bumps that commonly grow on your spinal bones or around your joints. Usually, they develop when you have osteoarthritis. The damage caused to your cartilage (tough flexible tissue that lines your bones and allows for smooth joint movement) by this condition means that a new bony growth may form around your joint, meaning that there is less space for your nerves to travel and increases the chances of compression.

Pinched nerve

You may experience a pinched (or trapped) nerve in your lower back when too much pressure is placed on your nerve by the surrounding tissue. This can happen due to arthritis, an injury, stress from repetitive movements during work, sports and/or physical activities, or obesity.

Sciatica

Sciatica, a fairly common condition that is more common among older people, develops when your sciatic nerve, which runs from your lower back through your buttocks and down to your feet, becomes irritated and/or compressed. This tends to happen in cases when you have a slipped disc or bone spurs that put pressure on your sciatic nerve. It can lead to inflammation, pain, and numbness in your leg.

Your consultant will ask you some questions about your back pain, such as there it sits, how severe it is, when it started, and whether you've had any treatment in the past (anti-inflammatory medication, physiotherapy, etc). They may also perform a brief physical examination, asking you to do certain exercises and seeing where and when you feel discomfort.

In addition to this, your consultant may need to do some imaging tests, as this gives them the best chance of confirming if you have any trapped nerves and/or bone spurs that are causing you pain and could be helped by an epidural for back pain.

X-ray

An X-ray produces images of the bones in your spine. This allows them to check if you have any bone spurs (bumps that form on your bones) or changes in the size of your bone that might reduce the space within your spinal canal, which may be subsequently causing your nerve compression.¹

MRI

Using powerful magnetic fields and radio waves, an MRI scan gives your consultant detailed images of your spinal cord and its surrounding structures, allowing them to see if there's any damage to your discs or ligaments, along with checking for tumours that may be the cause of your spinal nerve compression.

If these scans confirm that you have nerve compression in your lower spine, your consultant will most likely start by prescribing non-surgical treatments. These include anti-inflammatory medications (ibuprofen, naproxen, etc) that relieve pain and swelling, along with physical therapy exercises that strengthen your back. A brace may be given to you to support your back and enable you to do activities more safely. If you have already tried these treatments, they may suggest an epidural for back pain.

An epidural for back pain is a very simple procedure that doesn't require much preparation from you. Nonetheless, your consultant may speak to you about some things you can do in advance.

Discuss medications with your consultant

Any medications that thin your blood - warfarin, aspirin, anti-inflammatories, etc - can increase the likelihood of unwanted bleeding during and/or after your lumbar laminectomy. If you are on any of these, your consultant may suggest you stop taking them for two weeks before your visit to hospital.

Food and drink

Avoid eating or drinking after midnight on the day of your epidural for back pain, along with not drinking any alcohol for 48 hours prior to your procedure.

Arrange a lift home

You won't be able to drive home after your epidural for back pain, nor should you take public transport, so take care to arrange for a member of your support group or a taxi to take you home.

An epidural injection for back pain is an outpatient surgery, meaning you’ll be able to go home on the same day. The procedure only takes between 15 and 30 minutes, and generally follows the same steps:

• The site of your epidural injection will be cleaned, with your surgeon then injecting some local anaesthetic to numb the area
• Your surgeon will be using an X-ray to help them guide the epidural needle into the correct area of your back (this is known as a fluoroscopy)
• When the epidural needle is in place in the epidural space around your spinal cord, your surgeon will inject a contrast material, which make sure the needle tip is in your epidural space, as opposed to inside a blood vessel or other tissue
• They will then slowly inject the medication, which is a combination of anti-inflammatory medication and local anaesthesia, into your epidural space

After your epidural for back pain, your consultant will apply pressure to the injection site to prevent bleeding, cleaning the area once more ahead of applying a dressing. You'll be moved to a private space to rest for a little while, giving us a chance to see if you have any reactions to the medication before you go home.

You may experience some numbness after your epidural for back pain, but this will go away after four to six hours. Please take care to rest and not aggravate your problem by resting until the numbness is gone.

In the days following your epidural for back pain, you may notice a slight increase of pain. This is only because the steroid and local anaesthetic haven't had time to deliver their effects. Your pain should improve within 10 days of your injection, but you might experience relief sooner - even just one day after your epidural injection.

You should avoid some activities right after your epidural for back pain. Don't drive for 12 hours following the injection, and avoid any direct heat applied to the injection site for at least three days. You will be able to make a return to work 24 hours after your epidural injection.

Epidural for back pain is an extremely safe and common procedure, but some complications can nonetheless still occur. Your consultant will speak to you about these before arranging your visit to hospital.

General complications of any operation:

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of epidural for back pain

• Low blood pressure
• Loss of bladder control
• Itchiness
• Feeling sick
• Your pain doesn't go away
• Headaches
• Slow breathing
• Temporary or permanent nerve damage
• Fits
• Severe breathing difficulties
• Sleeping problems
• Anxiety
• Menstrual changes

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant fits your needs
• Personalised, consultant-led treatment plans tailored to your specific requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Lumbar epidural steroid injection, Cleveland Clinic
2. Epidural corticosteroid injections, John Hopkins Medicine 
3. Spinal stenosis, Mayo Clinic
4. MRI and low back pain, MedlinePlus 
5. Epidural injections for back pain, MedlinePlus
6. How long should you rest after an epidural?, New York Spine Specialist