Epidural Steroid Injection Side Effects: What to Know Before Your Procedure

Epidural steroid injections (ESIs) are among the most commonly performed interventional pain procedures in the United States. Every year, millions of patients receive epidural injections to manage pain caused by herniated discs, spinal stenosis, and other conditions that compress or inflame spinal nerves. For most patients, the procedure is safe, well-tolerated, and effective.

If you have been recommended an epidural steroid injection for low back pain, neck pain, or radiating leg or arm pain, it is completely normal to have questions about potential side effects. Understanding what to expect — and what is genuinely rare — can help you make an informed decision and feel more confident heading into your procedure.

This guide covers the full spectrum of epidural steroid injection side effects: common reactions that resolve on their own, less frequent effects worth knowing about, and the rare but serious complications that require medical attention. We also explain how to minimize your risk and what to expect during your recovery.

Common Side Effects — What Most Patients Experience

The majority of side effects from epidural steroid injections are mild, temporary, and self-limiting. Most patients experience one or two of the following and find that they resolve within a few days.

Temporary Pain Flare

Injection site soreness is the most frequently reported side effect. The area where the needle was placed may feel tender, achy, or slightly swollen for 1–3 days. Some patients also experience a temporary increase in their usual pain for 24–72 hours as the local anesthetic wears off before the steroid takes full effect. Applying ice for 15–20 minutes at a time and taking over-the-counter acetaminophen or ibuprofen can help manage this flare.

Steroid Flush

Facial flushing and warmth occurs in roughly 10–15% of patients, typically starting within hours of the injection and lasting 1–3 days. This is a harmless reaction to the corticosteroid and does not indicate an allergy. It may be accompanied by mild redness of the face and chest. No specific treatment is needed, though cool compresses can provide comfort.

Temporary Blood Sugar Elevation

Blood glucose increases are expected in patients with diabetes. Corticosteroids can raise blood sugar levels for 3–7 days following the injection. If you are diabetic, plan to monitor your glucose more frequently during this window and have a conversation with your prescribing physician about temporary medication adjustments if needed.

Mild Headache

Non-positional headaches may occur in the first day or two after the procedure. These are typically mild, respond to hydration and over-the-counter pain relievers, and should not be confused with a post-dural-puncture headache (a distinct and less common condition discussed below).

Sleep Disturbance

Difficulty sleeping for 1–3 nights after the injection is relatively common. The corticosteroid can cause a mild stimulant-like effect that disrupts your normal sleep pattern. This is temporary and typically resolves within a few days as the steroid is metabolized.

Water Retention

Mild fluid retention and bloating can occur due to the corticosteroid’s effect on sodium and water balance. You may notice slight puffiness or a 1–3 pound increase on the scale. This resolves within 1–2 weeks without any specific intervention.

Less Common Side Effects

The following side effects occur in a smaller percentage of patients. They are generally not dangerous but are worth being aware of so you can communicate with your care team if they arise.

Temporary Leg Weakness or Numbness

Transient weakness or heaviness in one or both legs can occur when the local anesthetic spreads to nearby motor nerves. This typically resolves within a few hours. It is one reason patients are advised not to drive themselves home after the procedure and to rest for the remainder of the day.

Anxiety or Mood Changes

Mood fluctuations, anxiety, or a feeling of restlessness may occur in the first few days after injection. Corticosteroids can affect mood-related neurotransmitters, and some patients report feeling “wired” or emotionally reactive. This is temporary and typically resolves within 3–5 days.

Decreased Immune Function

Mild, short-term immune suppression is a known effect of corticosteroids. For most healthy patients, this is clinically insignificant. However, patients who are immunocompromised or who have active infections should discuss timing with their physician. Dr. Qureshi will evaluate your individual risk factors before recommending the procedure.

Rare but Serious Side Effects

Infection

Epidural abscess or localized infection is extremely rare when sterile technique is used. Signs include increasing pain at the injection site several days after the procedure, fever, chills, or redness and warmth around the injection area. If you develop these symptoms, contact your doctor immediately.

Dural Puncture (Spinal Headache)

Accidental puncture of the dural membrane can cause a post-dural-puncture headache — a severe headache that worsens when standing and improves when lying flat. This occurs in approximately 0.5–1% of epidural procedures. Most cases resolve with bed rest, hydration, and caffeine. Persistent cases may require a blood patch procedure.

Nerve Damage

Permanent nerve injury is exceedingly rare with modern fluoroscopically guided techniques. Temporary nerve irritation can cause brief shooting pain during the procedure, but lasting damage is a very uncommon complication when the injection is performed by a specialist with appropriate imaging guidance.

Epidural Hematoma

Bleeding into the epidural space is a rare but potentially serious complication, most relevant for patients on blood-thinning medications. This is why Dr. Qureshi carefully reviews all medications before the procedure and may ask you to temporarily discontinue certain blood thinners with the approval of your prescribing physician.

Allergic Reaction

True allergic reactions to the medications used in epidural injections are very uncommon. If you have known allergies to contrast dye, local anesthetics, or corticosteroids, inform your physician before the procedure so alternatives can be arranged.

How to Minimize Side Effects

While no medical procedure is entirely without risk, there are several things you can do to reduce the likelihood and severity of side effects from an epidural steroid injection.

Choose a qualified interventional pain specialist. The single most important factor in minimizing complications is having your injection performed by a board-certified physician who specializes in interventional spine procedures and uses fluoroscopic (X-ray) guidance for every injection. This ensures precise needle placement and significantly reduces the risk of complications such as dural puncture or nerve injury.

Disclose your full medical history. Inform Dr. Qureshi about all medications you take — including over-the-counter supplements and blood thinners — as well as any history of diabetes, bleeding disorders, infections, or allergies. This information allows your physician to tailor the procedure to your specific risk profile.

Follow pre- and post-procedure instructions carefully. Adhering to guidelines about medication holds, fasting, activity restrictions, and follow-up appointments helps ensure the safest possible outcome. Avoid strenuous activity for 24–48 hours after the injection, and keep the injection site clean and dry.

Do not exceed the recommended injection frequency. Current guidelines suggest no more than 3–4 epidural steroid injections per year to minimize cumulative steroid exposure. If your pain returns frequently, Dr. Qureshi may recommend complementary treatments such as radiofrequency ablation, nerve blocks, or physical therapy to reduce your reliance on repeated injections.

When to Call Your Doctor

The Bottom Line

Epidural steroid injections have a well-established safety profile supported by decades of clinical use. For the vast majority of patients, the procedure produces only mild, temporary side effects — injection site soreness, a brief pain flare, or a night or two of poor sleep. Serious complications are rare, especially when the procedure is performed by an experienced interventional pain specialist using image guidance.

The key to a safe and effective experience is choosing the right physician, communicating openly about your health history, and following post-procedure instructions. If you have been recommended an ESI procedure and want to discuss whether it is the right option for your situation, Dr. Qureshi is happy to answer your questions during a consultation.