Epidural Corticosteroid Injections for Sciatica

If you have sciatica—nerve pain that causes discomfort in your lower back, buttocks, and thigh—you may have tried many different treatments to find relief. For some individuals, epidural steroid injections may be used to treat this condition.

This medication is given via a shot in the lower back by the spinal cord. This helps decrease pain and swelling around the nerve root, which is a bundle of fibers that comes off of the spinal cord and extends to other areas in the body.

This article explains what an epidural steroid shot is, the benefits, how it's given, and its side effects. Information on other treatment options is also provided.

What Are Steroid Shots for Sciatica?

Epidural injections are one of the most common treatment options for managing lower back pain, including sciatica, also known as lumbar radiculopathy. With these injections, cortisone or another corticosteroid is placed into the tissue directly around where the pinched nerve meets the spine in an area known as the epidural space.

As an anti-inflammatory, the corticosteroid relieves inflammation around the nerve. This can reduce pain in the back and the radiating pain related to sciatica, which might be felt in your legs or other areas.

Steroids, including corticosteroids, are very powerful. They should be used at the lowest strength possible while still being effective.

There are different types of corticosteroids that can be used to treat sciatica, and each has different guidelines for how much medication should be used. Your healthcare provider will determine which medication is best for you.

How Epidurals Are Administered

An epidural shot is usually given at a radiology facility. Before inserting the needle that will go into the epidural space, your healthcare provider will inject a local anesthetic into the skin at the location of the epidural. This will numb the area, so you don't feel pain. However, you may still feel mild discomfort when the epidural is administered.

You will need to lie on your stomach for the procedure. Your provider may use fluoroscopy, an imaging tool, to guide them as they find the right location for the injection. Once it's located, they will insert the needle and release the medication into the epidural space.

The entire process takes between 10 and 20 minutes. Afterward, you will be monitored for a short time. You should be able to sit up and walk almost immediately. You should not drive yourself home, however.

If the pain continues or returns, you can repeat the injections within two to four months. However, the shots cannot be repeatedly offered and are not advised for long-term use.

Benefits

The benefits of epidural steroid injections vary significantly from person to person. Some people feel no change in their level of pain. Other people experience short-term relief. Still others enjoy long-lasting benefits and significantly less pain and discomfort for an extended period.

For some people with sciatica, epidural injections are not the end treatment. Instead, the injections are used in cooperation with surgical procedures to ensure the best long-term outcome.

Side Effects

Epidural steroid injections are usually considered low-risk procedures that cause few side effects. However, there are some possible negative experiences that can result from receiving these shots:

• Flushing in your face or chest with increased body temperature
• Sleep disruptions
• Anxiety
• Menstrual changes
• Water retention

While it's not common, some people experience more pain, at least for a few days after the injection. In other rare instances, serious complications might occur. The most common of these is an allergic reaction.

Other possible problems include nerve damage, infection, and possible paralysis.

How Effective Are Steroid Shots for Sciatica?

Research on steroid shots for sciatica is limited.

One study looked at the effect of three different injections in the spine. About 80 individuals with sciatica either received steroid injections, an arthritis medication, or salt water injections (a placebo, or sham treatment). Each person received two injections spaced two weeks apart.

Results gathered one month after the last injection found more improvement in symptoms with the epidural steroids than with the other treatments. However, the improvement was not significant when compared to the arthritis medication or salt water injection.

Another study noted that:

• Epidural steroid shots given to individuals with acute sciatica, or those with a recent onset of symptoms, helped reduce inflammation associated with the early stages of this condition.
• Individuals given these injections during the early stages of sciatica had better pain relief and improved functioning compared to individuals just given pain medication.

Other Options

There are other options for sciatica relief either as an addition to steroid shots or as an alternative to them.

Your healthcare provider may also prescribe other medications, physical therapy exercises, or non-surgical therapy like spinal decompression to attempt to treat your problem. In some cases, surgery may also be recommended.

Physical Therapy

Research indicates that exercise is one of the best and safest treatments for lumbar radiculopathy. A visit to your physical therapist can help you find the right exercises for your needs.

Many people with back pain benefit from physical therapy programs like the McKenzie Method, which specifically focuses on assessing and managing lower back pain.

While some individuals get relief from strengthening their core and hip muscles, others may require a combination of stretching and strengthening to help treat their back pain.

Exercises to try for back pain may include:

• Prone press-ups, which involve positioning yourself like you're about to do a push-up and pressing your shoulders up while your hips and low back relax
• Press-ups with hips off center, which involve doing a press-up exercise with your hips off to the side
• Flexion rotation stretches, which involves lying on your side with your lower leg straight and top leg bent
• Lumbar side glides, a standing exercise you do close to a wall
• Pelvic tilts, which are done while lying on the floor with your knees bent and feet on the floor

Proper treatment may help improve your spinal motion and decrease or eliminate your pain.

Non-Surgical Spinal Decompression 

For non-surgical spinal decompression, your physical therapist uses equipment to gently stretch the spine. This is meant to take pressure off of compressed nerves that may be causing sciatica.

While some people have said they found relief from the procedure, there is limited research-based evidence that it's an effective way to treat sciatica.

Surgery

Surgical decompression is usually only considered as a last resort if other methods of relieving pain have not worked.

During the procedure, your surgeon performs a laminectomy. This is when a portion of the vertebrae, known as the lamina—the bony walls of the vertebrae—are removed. This is usually done if there are bone spurs on the lamina that are placing pressure on the nerves in the spine.

Removing these bones may relieve the pressure, making your pain disappear.

Summary

Epidural steroid shots for sciatica may help some individuals experience symptom relief. This may be especially true for those with acute sciatica. However, research is limited.

Other treatments for sciatica include physical therapy and exercise. Be sure to check in with your healthcare provider and physical therapist before beginning a treatment program.

Non-surgical spine decompression is another treatment option with little evidence to show effectiveness. Still, you may want to discuss this procedure with your healthcare provider if you haven't gotten relief from other non-invasive treatments. Surgery may be necessary for severe and debilitating cases of sciatica.