After an epidural steroid injection, most people experience a temporary increase in pain for the first 24 to 48 hours before the steroid begins working. You’ll likely feel some numbness or heaviness in your legs from the local anesthetic used during the procedure, and this wears off within a few hours. The full pain-relieving effect of the steroid typically kicks in within several days, though the timeline varies from person to person.
The First Few Hours
The local anesthetic injected alongside the steroid works immediately, so you may feel significant pain relief right on the table. That relief is temporary. As the anesthetic fades over the next two to six hours, you may notice numbness, tingling, or mild weakness in your legs. This is normal and resolves on its own, though in rare cases it can linger up to 48 hours.
Because of that temporary numbness and the sedation some clinics use, you cannot drive yourself home. Plan to have someone with you. Most people can resume normal activities the next day, but Cleveland Clinic recommends avoiding lifting anything heavier than 20 pounds for 48 hours after the procedure.
The Post-Injection Pain Flare
Once the local anesthetic wears off, your original pain often comes back, and it can actually feel worse than before. This is called a steroid flare, and roughly half of patients experience one. The flare likely results from a combination of needle irritation and the steroid crystals settling into the tissue around the injection site. It can be uncomfortable, but it’s not a sign that something went wrong.
Most flares improve by day two. If your pain is still getting worse after 48 hours, or if the pain moves to a new location, contact your doctor. Applying ice or a cold pack to the injection site for 10 to 20 minutes at a time (with a thin cloth between the ice and your skin) can help during this window.
Common Side Effects
The steroid component can cause a handful of side effects that have nothing to do with your spine. These are systemic reactions to the medication circulating in your body, and they typically last a few days:
- Facial and chest flushing: a warm, reddened feeling that can last several days
- Sleep disruption: difficulty falling or staying asleep for one to three nights
- Elevated blood sugar: particularly relevant if you have diabetes, so monitor your levels closely
- Anxiety or irritability: a temporary mood shift from the steroid
- Menstrual changes: irregular or missed periods in the cycle following the injection
- Injection site soreness or skin discoloration: mild bruising or lightening of the skin near the injection
None of these are dangerous, but the blood sugar effect deserves attention if you manage diabetes. Talk with your doctor beforehand about adjusting your insulin or medication for the days following the injection.
When Pain Relief Actually Begins
The steroid needs time to reduce inflammation around the compressed or irritated nerve. Most people notice meaningful improvement within three to seven days, though some don’t feel the full benefit for up to two weeks. If you’re evaluating whether the injection “worked,” give it at least that long before drawing conclusions.
For sciatica caused by a herniated disc, the success rates are encouraging. A 2024 meta-analysis pooling data from multiple clinical trials found that 60 to 86 percent of patients reported more than 50 percent pain reduction after epidural steroid injections. Results varied across studies, but even the lower end of that range represents a meaningful improvement for most people dealing with nerve pain that limits daily life.
Pain relief from a single injection can last weeks to several months. Some people get lasting benefit from one or two injections. Others find the relief fades and need repeat treatments.
Activity Restrictions and Self-Care
Take it easy the day of the procedure. Rest at home, ice the injection site as needed, and avoid strenuous activity. The next day, you can drive and return to work or your usual routine unless your doctor says otherwise. Hold off on heavy lifting for the full 48 hours.
If you were taking blood thinners or aspirin before the procedure, your doctor will have had you stop them beforehand. Follow their specific instructions on when to restart. For soreness at the injection site, ask about over-the-counter pain relievers if you’re not already on a prescription.
How Many Injections You Can Get
Epidural steroid injections are limited to four per spinal region in a 12-month period. This cap exists because repeated steroid exposure can weaken nearby bone and soft tissue over time. Your doctor will space injections at least two to four weeks apart to assess how well each one works before deciding whether another is warranted.
If the first injection provides partial relief, a second or third may build on that improvement. If it provides no relief at all, repeating the same injection is unlikely to help, and your doctor will typically explore other options.
Red Flags Worth Knowing
Serious complications are rare, but certain symptoms after the procedure need prompt medical attention. Contact your doctor if you experience pain that worsens beyond 48 hours or shifts to a different part of your body. Fever, severe headache (especially one that worsens when sitting or standing), new weakness in your legs, or any change in bladder or bowel control all warrant an immediate call. These could signal infection, a spinal fluid leak, or nerve injury, all of which are treatable but require fast evaluation.