Medically reviewed by: Dr. John A. Serpa, MD, DABA, board-certified in Anesthesiology with a subspecialty in Pain Medicine
Last updated: October 23, 2026
If sciatica pain from a herniated disc hasn’t eased with rest, medication, or physical therapy, an epidural steroid injection may be the next step. It places anti-inflammatory medication right next to the irritated nerve root, using live X-ray to guide the needle. The procedure takes about 15 to 30 minutes, you go home the same day, and relief usually builds over several days.
TL;DR Medical Summary:
- An epidural steroid injection treats sciatica by calming inflammation around a pinched lumbar nerve root.
- It’s an outpatient, X-ray-guided procedure that takes 15 to 30 minutes.
- Relief varies; most people get about four to six weeks.
- Up to three injections a year, paired with physical therapy.
What is an epidural steroid injection, and how does it help sciatica?
An epidural steroid injection delivers a steroid and a numbing medication into the epidural space, the area around the nerve roots as they leave your spine. When a herniated disc presses on a nerve root, inflammation often causes the pain that shoots down your leg, and the steroid targets that inflammation.
Sciatica follows the path of the sciatic nerve, which forms from nerve roots in the lower back (most often L4, L5, and S1). A herniated disc happens when the soft center of a spinal disc pushes through its tougher outer ring. The pressure matters, but so does the chemical irritation that follows. That’s why reducing inflammation can ease leg pain even though the disc itself hasn’t changed.
The injection isn’t meant to be a permanent fix. Its job is to bring pain down enough that you can move, sleep, and do the physical therapy that builds lasting improvement. Many people with sciatica from a disc get better over time without surgery, and the injection can make that recovery period easier to get through. Read more on our Sciatica & Herniated Discs page.
Who is a good candidate for an epidural steroid injection?
Good candidates have pain that travels down one leg along a nerve path and hasn’t improved enough with conservative care. Dr. Serpa confirms the source with a history and physical exam before recommending an injection.
Signs that point toward nerve root irritation include:
- Sharp, burning, or electric pain from the lower back or buttock down the leg
- Numbness or tingling that follows the same path
- Leg pain that’s worse than back pain
- Pain that flares with sitting, coughing, or sneezing
An MRI is not always required before an injection. Dr. Serpa decides based on your symptoms, exam, and history whether imaging is needed first.
How should I prepare for an epidural steroid injection?
The most important step is reviewing every medication you take, especially blood thinners. Blood thinners must be held before an epidural, but only on specific instructions from your doctor.
Blood thinners (anticoagulants): There are many types, and each needs a different plan. Dr. Serpa will go over your specific medication and how long it should be paused. Depending on why you take it, he may need to speak with your primary care doctor or cardiologist to agree on a safe plan. In some situations it isn’t safe to stop these medications at all.
Important: Never stop or interrupt a blood thinner on your own. Only stop it when your doctors give you specific instructions.
Other preparation steps:
- Tell us if you have diabetes. Steroids can raise blood sugar for a few days, so you may need to check it more often.
- Let us know about allergies, especially to contrast dye or iodine.
- Arrange a ride home.
- Wear comfortable clothing.
What happens during the procedure, step by step?
You lie face down while Dr. Serpa uses live X-ray (fluoroscopy) to guide a thin needle into the epidural space. Contrast dye confirms the needle is in the right place before any medication goes in.
- Check-in and review. We go over your medications, allergies, and consent.
- Positioning. You lie face down, and the skin over your lower back is cleaned.
- Numbing. A local anesthetic numbs the skin. You stay awake, though sedation is available.
- Guided placement. Using fluoroscopy, Dr. Serpa guides the needle to the target level.
- Contrast check. A small amount of dye shows where the medication will spread.
- Injection. The steroid and numbing medication are delivered.
- Recovery. You rest briefly while we monitor you, then go home with your driver.
Which approach will my doctor use?
There are three ways to reach the epidural space, and all three are performed under fluoroscopic guidance. Dr. Serpa chooses based on your anatomy, the level involved, and your symptoms.
| Approach | How it reaches the nerve | How often Dr. Serpa uses it |
|---|---|---|
| Interlaminar | Between two vertebrae, from behind | Most common |
| Transforaminal | Through the side opening where the nerve root exits | Second most common |
| Caudal | Through a small opening near the tailbone, sometimes with a thin catheter guided up to the target level | Less common |
Does an epidural steroid injection hurt?
Most people feel a brief sting from the numbing medication, then pressure rather than sharp pain. Some notice a short flare of their usual leg pain as the medication spreads.
Soreness at the injection site for a day or two is common, and ice can help. Your usual symptoms may also return or feel slightly worse for a short time once the numbing medication wears off, before the steroid starts working.
How long does relief last, and how many injections can I have?
Relief is variable. In Dr. Serpa’s experience, most people get pain relief lasting about four to six weeks.
The steroid usually takes several days to take effect. We see you for follow-up within three weeks to judge two things: whether your pain has improved, and whether you’re functioning better. From there, you and Dr. Serpa decide together whether a second injection makes sense or whether continued conservative care is the better path.
Epidural steroid injections are usually limited to three within a year, because repeated steroid exposure carries its own risks. If injections give only brief relief, that’s useful information. It may point to a different pain source or a different treatment. See our Epidural Steroid Injections procedure page for more detail.
What are the side effects and risks?
Most side effects are mild and short-lived. Serious complications are uncommon when the injection is guided by imaging.
Common and temporary:
- Soreness at the injection site
- A brief increase in leg or back pain
- Facial flushing or a warm feeling
- Trouble sleeping for a night or two
- Higher blood sugar for a few days, which matters if you have diabetes
Uncommon but serious:
- Infection
- Bleeding
- A headache that’s worse when sitting or standing and better lying down, which can mean the spinal fluid sac was punctured
Call our office right away if you develop a fever, severe or worsening pain, new weakness or numbness, or a headache that changes with position.
How does an epidural compare with other sciatica treatments?
Epidurals sit between conservative care and surgery. They’re often used when conservative care alone isn’t enough but surgery isn’t needed yet.
| Option | What it involves | When it’s typically considered |
|---|---|---|
| Conservative care | Rest, medication, physical therapy, activity changes | First, for most people |
| Epidural steroid injection | Outpatient, X-ray-guided injection, 15 to 30 minutes | When leg pain persists despite conservative care |
| Spinal cord stimulation | Small implanted device that changes how pain signals reach the brain | Long-lasting nerve pain that hasn’t responded to other treatment |
| Surgery (such as microdiscectomy) | Removing the part of the disc pressing on the nerve | Severe or progressive weakness, or disabling pain that doesn’t improve |
Learn about Spinal Cord Stimulation, or compare this with radiofrequency ablation for facet joint pain, a different source of low back pain.
When is sciatica an emergency?
Most sciatica is not an emergency, but a few symptoms are. Go to the emergency room or call 911 if you have any of these:
- Loss of bladder or bowel control, or being unable to urinate
- Numbness in the groin, inner thighs, or buttocks
- Weakness in one or both legs that is getting worse
- Back pain with a fever
These can be signs of severe nerve compression or infection that needs urgent treatment.
What’s the next step?
The right plan starts with an accurate diagnosis. At Today I Have No Pain in Hialeah, Dr. Serpa evaluates where your pain is coming from and explains your options, including whether an epidural fits your case, before recommending treatment. Se habla español.
Request an appointment or call (305) 698-9077. Browse more patient guides.
Frequently asked questions
The procedure itself takes about 15 to 30 minutes. You go home the same day, but you’ll need someone to drive you.
Relief varies from person to person. Most people get about four to six weeks of relief, and a follow-up within three weeks helps decide whether another injection or continued conservative care is best.
Epidural steroid injections are usually limited to three within a year. That limit helps reduce the risks of repeated steroid exposure.
Blood thinners usually must be held before an epidural, but never stop one on your own. Your doctor will give specific instructions and may coordinate with your primary care doctor or cardiologist, since stopping isn’t always safe.
This guide is for general education and does not replace a personal medical evaluation. Treatment decisions depend on your history, exam, and imaging. If you have a medical emergency, call 911.