A lumbar epidural steroid injection is generally less painful than most people expect. The area is numbed with a local anesthetic before the larger needle is placed, so the sharpest sensation most patients feel is a brief pinch from that initial numbing shot. During the injection itself, the typical experience is pressure, tingling, or a brief burning sensation rather than sharp pain.
What You’ll Actually Feel During the Procedure
The procedure happens in stages, and each one feels different. First, the skin over your lower back is cleaned and draped. Then a local anesthetic (usually lidocaine) is injected into the skin and tissue near the spine using a small 25-gauge needle. This is the part most patients describe as a pinch or sting. There’s some irony here: lidocaine numbs the area but briefly causes its own pain going in. The sting typically fades within seconds as the numbing takes effect.
Once the area is numb, the doctor advances a larger needle, commonly a 17- or 18-gauge Tuohy needle, toward the epidural space surrounding your spinal nerves. Some clinics use a smaller 20-gauge needle to improve comfort, though these can be slightly less reliable for finding the right space. Because the tissue is already numbed, most patients feel pressure or a pushing sensation rather than pain during this step. You may also feel a momentary burning or tingling as the steroid and anesthetic mixture flows into the epidural space. That fullness or pressure is the fluid spreading around the nerve roots and is normal.
The entire injection typically takes only a few minutes once positioning is complete.
When Pain During the Procedure Is a Warning Sign
There’s an important distinction between normal pressure and something that needs immediate attention. If you feel a sudden, sharp, electric-like pain that shoots down your leg during needle placement, speak up right away. This type of radiating pain can indicate the needle is touching a nerve root. Research published in JA Clinical Reports found that when patients report this sensation and the needle is promptly pulled back, nerve injury is typically avoided. The radiating pain itself serves as an early warning, and responding to it quickly is the main safeguard.
Normal sensations during the injection (pressure, dull aching, mild burning, tingling at the injection site) do not carry the same concern. The key difference is location and quality: a shooting, electric sensation traveling into your buttock or leg is the signal to tell your doctor immediately.
Sedation vs. Local Anesthetic Only
Most lumbar epidural steroid injections are done with local anesthetic alone, meaning you’re fully awake. For patients with significant anxiety, difficulty lying still, or complex spinal anatomy that makes the procedure more involved, monitored anesthesia care (sometimes called “twilight sedation”) is an option. This involves an anesthesiologist administering IV medication to keep you relaxed or lightly sedated while still breathing on your own. The sedation level can be adjusted in real time based on how you’re feeling.
If you’re concerned about pain tolerance, it’s worth asking your provider ahead of time whether sedation is available at their facility. Many pain clinics offer it routinely, while others reserve it for specific situations.
Soreness and Pain After the Injection
The injection site will likely be sore for the first day or two. This is the most common side effect and feels similar to a deep bruise in the lower back. Ice and over-the-counter pain relief are usually enough to manage it.
A steroid flare is a separate phenomenon worth knowing about. This is a temporary increase in pain that happens as the steroid crystals settle into the tissue before they begin reducing inflammation. Research on steroid injections found that roughly 35% of patients experience a flare, with symptoms lasting an average of about 4 days (ranging from 1 to 7 days). During a flare, your original back or leg pain may actually feel worse than before the injection. This can be discouraging, but it doesn’t mean the injection failed. The anti-inflammatory effect of the steroid typically kicks in within a few days to a week after the flare resolves.
If your pain gets significantly worse after 48 hours or starts appearing in a new location, that warrants a call to your provider’s office. The same goes for fever, new weakness in your legs, or difficulty with bladder control, which are rare but need prompt evaluation.
Factors That Affect How Much It Hurts
Not everyone experiences the same level of discomfort. Several things influence your individual experience:
- Body habitus: In patients with more tissue between the skin and spine, the needle path is longer, which can mean slightly more pressure sensation even with good numbing.
- Spinal conditions: If you have significant arthritis, spinal stenosis, or prior back surgery, the anatomy can be more difficult to navigate. This sometimes means more needle repositioning, which extends the uncomfortable portion of the procedure.
- Anxiety level: Muscle tension from anxiety can make the needle insertion feel more uncomfortable and make it harder for the doctor to find the epidural space. Slow, deliberate breathing genuinely helps relax the paraspinal muscles.
- Provider experience: A provider who does these injections regularly, especially with fluoroscopic (X-ray) guidance, tends to place the needle more efficiently with fewer adjustments.
For most people, the anticipation is worse than the procedure itself. The local anesthetic does the heavy lifting, and the actual epidural injection lasts only seconds. The soreness afterward is real but manageable, and a steroid flare, if it happens, is temporary.