Sciatica is a common condition that affects millions of people worldwide. It can be absolutely debilitating and disrupt daily life, making it difficult to sit, stand or move without pain. If you suffer from sciatica, you may have heard of epidural steroid injections as a treatment option. But how do they work, and are they the right choice for you?
VIDEO: How Dr. Brandon Hirsch Treats Sciatica
What is Sciatica?
Sciatica is not a condition in itself, but rather a symptom of an underlying issue affecting the sciatic nerve. The sciatic nerve is the longest and widest nerve in the human body, running from the lower back and down each leg. When this nerve becomes compressed or irritated, it can lead to sciatica.
Common causes of sciatica include:
- Herniated Disc: When a disc in the spine bulges or ruptures, it can press against the sciatic nerve.
- Spinal Stenosis: Narrowing of the spinal canal can put pressure on the sciatic nerve.
- Degenerative Disc Disease: Wear and tear on spinal discs over time can contribute to sciatic nerve compression.
- Piriformis Syndrome: The piriformis muscle in the buttocks can sometimes irritate the sciatic nerve.
- Spondylolisthesis: When a vertebra slips forward over another, it can pinch the sciatic nerve.
Sciatica symptoms are different for everyone, but commonly include:
- Sharp, shooting pain that radiates from the lower back to the leg.
- Burning or tingling sensations in the leg or foot.
- Numbness or weakness in the affected leg.
- Pain that worsens with prolonged sitting or sudden movements like coughing or sneezing.
- Difficulty walking or standing for long periods.
Severe sciatica can lead to long-term nerve damage if left untreated, so it’s essential to seek treatment as soon as you notice symptoms.
"Sciatica can be incredibly uncomfortable, but the good news is it’s treatable. It’s not a condition itself, but a sign that something’s irritating your sciatic nerve, like a herniated disc or tight muscles. Since sciatica itself isn't a condition, we first want to identify what's causing your sciatic pain. From there, we have many treatment options at our disposal. With the right treatment and a little patience, most people find real relief and get back to doing what they love."
Leia Rispoli, MD | Interventional Pain Management Specialist and Physiatrist
How Do Epidural Steroid Injections Work?
Epidural steroid injections are a common non-surgical conservative treatment for sciatic pain. These injections deliver a combination of anti-inflammatory medication called corticosteroids and a local anesthetic directly into the epidural space surrounding the spinal cord and nerve roots.
Epidurals provide relief by reducing inflammation and numbing the pain. The corticosteroid reduces inflammation around the sciatic nerve, helping to relieve pain, and the anesthetic provides immediate relief by numbing the area. By reducing pain and inflammation, epidurals can help patients regain mobility and participate in physical therapy for long-term improvement.
Receiving an epidural usually involves these steps:
- The patient typically lies on their stomach or side.
- The injection site is cleaned and numbed with a local anesthetic.
- Using fluoroscopy (X-ray guidance), the doctor inserts a needle into the epidural space.
- The steroid and anesthetic mixture is injected, and the needle is carefully removed.
The entire process takes about 15-30 minutes, and patients are usually monitored for a short time before being discharged.
“When sciatica flares up, an epidural steroid injection can be a powerful tool for relief. It works by delivering anti-inflammatory medication and a numbing agent directly to the irritated nerve roots in your spine, calming the inflammation and easing the pain. It’s a minimally invasive option that can make a big difference in your recovery. But keep in mind –– this method is great for treating pain, but does not treat the underlying cause of your sciatic nerve pain. ”
Dickran V. Altounian, DO, MS | Pain Management
Why You May Want to Consider Getting an Epidural
Many patients with sciatica find significant relief from epidural steroid injections, and it may be a good conservative care option to pursue before looking into more invasive treatment options. Epidurals are a good choice if you’re looking for:
- Fast Pain Relief: Epidurals often provide quick pain relief, allowing patients to return to daily activities sooner than with oral medications alone.
- A Minimally Invasive Procedure: Unlike surgery, epidural injections are minimally invasive and do not require long recovery times.
- Something Temporary but Effective: While not a permanent solution, epidural injections can provide relief for weeks to months, allowing time for the underlying condition to improve.
- Help Avoiding Surgery: For many patients, epidurals provide enough relief to delay or eliminate the need for surgical intervention.
Considerations Before Getting an Epidural
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While epidural injections can be very effective for many people, they don’t always provide lasting relief—especially if there’s a more serious underlying issue like a herniated disc or spinal stenosis. If the pain persists or starts to interfere with your daily life, it may be time to talk surgical options. Surgery can directly address the root cause of the sciatica and, for the right patient, offer long-term relief.”
Ali H. Mesiwala, MD | Microscopic & Reconstructive Spine Surgeon
On the flip side, while epidural injections can be highly effective, there are some factors to consider:
- Temporary Relief: Pain relief typically lasts a few weeks to a few months. Repeat injections may be needed but are usually limited to three per year to avoid side effects.
- Potential Side Effects: Side effects may include mild headaches, temporary numbness or increased pain at the injection site. Rare but serious risks include infection, nerve damage, or allergic reactions.
- It’s not a cure, it’s symptom relief: Epidurals treat symptoms, not the root cause of sciatica. They work best when combined with physical therapy, exercise, and lifestyle modifications.
- Individual Effectiveness Varies: Some patients experience significant relief, while others may see only mild improvements.
In severe cases, when conservative treatments aren’t enough, surgical options like a discectomy or spinal decompression may be necessary.
Sciatica can be painful and disruptive, but conservative treatments like epidural steroid injections offer relief for many patients. If you're considering an epidural, consult with your doctor to discuss whether it’s the best option for your specific condition and situation. While injections can provide temporary relief, addressing the root cause through physical therapy, lifestyle changes (and potentially more invasive alternative treatments) is key to long-term recovery.
By understanding your options, you can make informed decisions about managing your sciatic pain and improving your quality of life. If you’d like to discuss your options with a spine specialist, set up a consultation at DISC today.
