Search IconSearch

Why Steroid Injections Don’t Always Help Your Back Pain, and What To Do About It

Back pain often has multiple causes, only some of which an epidural steroid injection can relieve

Person recieving an epidural injection in thier spine.

If you’ve never struggled with back pain… Congratulations! You’re basically a unicorn!


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The vast majority of people on this planet will experience back pain at some point in their lifetime. In fact, lower back pain is the most common musculoskeletal problem around the world. 577 million people were living with lower back pain in the year 2017 alone. That’s a lot of people — and a whole lot of pain. And the number would likely stretch into the billions if you included upper and mid-back pain.

If your pain is particularly bad, your healthcare provider may recommend a procedure called an epidural steroid injection (ESI). Pain management specialist Paul Shin, MD, describes ESIs as “a spinal procedure where a mixed solution of local anesthetic and corticosteroid is injected into an epidural space. This is an area where the medicine can block nerves or nerve roots.”

When ESIs work, they can be life-changing.

But they don’t always work. And when they don’t work, it can be incredibly disheartening.

We asked Dr. Shin why ESIs have such unpredictable results and what to do when they don’t make a dent in your discomfort.

What can epidural steroid injections help treat?

ESIs are more likely to provide significant improvement in your back pain if you’re dealing with issues involving your nerves. Examples include:


Your pain management specialist isn’t going to inject your back without doing some investigating first. Dr. Shin says you can expect to get a physical exam and imaging studies — like X-rays, CT scans or MRIs — done before there’s any discussion of an ESI.

They’ll also review your medical history and ask about how you’ve responded to previous back pain treatments. With all that information, your physician can make an educated guess about the origin(s) of your pain and how effective an ESI will be.

“Because of the different reasons for back pain, epidural steroids can bring weeks of pain relief to some people, months of relief to others and forever relief to a fortunate few,” Dr. Shin clarifies. If you’re lucky enough to get six or more months of pain relief, Dr. Shin says providers will consider repeating the injection if your pain returns.

But in some cases, ESIs only work for a few days — or worst-case scenario, don’t help at all.

Why epidural steroid injections may not always work

According to Dr. Shin, the outcomes of ESIs are unpredictable for a few reasons. One of them is the complexity of the problem ESIs attempt to solve.

“Back pain can come from multiple areas of the back,” Dr. Shin explains. “The pain may involve the nerves, the nerve roots, the vertebrae, the facet joints, the muscles or a combination.”

ESIs are often successful when used on back pain that involves nerves. But if the primary cause of your pain is a fracture, arthritis or muscle strain, the outcome is more uncertain. The outcome is even hazier if there are several different issues going on at once, as is often the case.

It’s also important to remember that ESIs aren’t usually fixing the underlying cause of your back pain. They can be extremely effective tools for pain relief, but if you have degenerative disk disease, for example, what works one year may not work as effectively — or at all — the next.

Side effects of ESIs

While generally safe and well-tolerated, ESIs — as you can probably imagine — aren’t pain-free procedures. You’re likely to experience some discomfort when you get the injection and may be a bit sore for a day or so afterward.

While rare, side effects can happen. The most common side effects of ESIs are:

  • Infection.
  • Allergic reactions.
  • Local bleeding.
  • Rupture of a tendon.
  • Prolonged pain.
  • Skin discoloration.

It’s more common for an ESI to be ineffective than it is to experience severe side effects.

While failing to relieve your back pain certainly isn’t the goal, it also shouldn’t leave you feeling worse than you did beforehand.

Unless you get too many ESIs. That, it turns out, can do lasting damage.

Risks of ESIs

Epidural steroid injections can do a world of good, but only when they’re used in moderation. Getting ESIs too frequently can put you at risk for:

If getting more frequent injections is off the table, what do you do next? Dr. Shin says that if you’re not seeing much in the way of benefits after an ESI, or the benefit doesn’t last for very long (think days or weeks, as opposed to months), it’s time to have a conversation with your provider.


“I recommend talking with your doctor about all the interventional tools available for your specific type of back pain, not just ESIs,” he says.

Alternative treatments for back pain

  • Exercise. It may feel like the last thing you want to do when your back is hurting, but building your core muscles and keeping your spine mobile with gentle exercises and stretching will be beneficial in the long run.
  • Physical therapy. What you do in physical therapy looks different depending on the cause of your pain. Strength training, stretching, massage and hydrotherapy are just a few of the possible approaches your physical therapist may take to get you feeling better.
  • Medication. Pain medication — even the over-the-counter stuff — can cause side effects, so it’s important that you talk to your doctor before you make any changes. Depending on what’s causing your back pain, there may be different pain relief options available to you.
  • Heat and cold therapy. Depending on the cause of your back pain, your provider might advise you to apply heat, ice or a combination of the two. Just make sure you’re careful to protect your skin and limit the amount of time you have the heating pad or ice pack on your back.
  • (Limited) Bed rest. Some back issues require that you go horizontal for a while, but it’s important to avoid being too sedentary. Not moving for long periods of time can slow down your recovery and, in some cases, actually increase the amount and duration of your pain.

Getting your back on track

Epidermal steroid injections are a great option to address many causes of back pain. But they aren’t foolproof. They’re less likely to be effective for back issues that don’t have — or only have minor — nerve involvement.

If you’ve had an ESI and found it ineffective, have a conversation with your healthcare provider. It’s dangerous to get the procedure too frequently, and they may be able to suggest alternatives that will provide more relief.


Learn more about our editorial process.

Related Articles

Healthcare provider checking patient's knee
June 19, 2024/Chronic Pain
Arthritis Exercise: What To Try and What To Avoid

Exercising can actually improve arthritis symptoms — and low-impact exercises are best

Person shoveling snow
March 14, 2024/Wellness
Shoveling Snow? Tips To Prevent Back Injury or Pain

Stretch before heading outside, keep proper form and avoid jerking or twisting to throw snow

Patient at doctor office with physician checking their back
March 11, 2024/Chronic Pain
Is It Time To See a Doctor for My Aching Back?

It’s always a good idea to let a healthcare provider know about any back pain you’re experiencing, especially if it results from trauma or persists longer than three months

physical therapist working with patient on their back
March 4, 2024/Chronic Pain
12 Ways To Treat Your Back Pain Without Surgery

From physical and biofeedback therapy to nerve ablations and blocks, there are many nonsurgical options for managing back pain

Close up of hand in blue gloves inserting dry needling into muscles
February 13, 2024/Chronic Pain
What’s the Difference Between Dry Needling and Acupuncture?

Both can help reduce pain, but they’re very different in terms of origins, philosophies and practices

Close up of gloved hands holding hot drink, steaming mug, outside in the cold
January 17, 2024/Chronic Pain
10 Cold Weather Tips for Managing Raynaud’s During Winter

Use foot warmers and hand warmers, layer your clothing and avoid sharp shifts in temperature

Close up of dry needling
December 14, 2023/Chronic Pain
Dry Needling: What It Is and How It Works

As part of a larger treatment strategy, it can help decrease muscle tightness and reduce pain

Person rubbing painful wrists and hands on lap.
November 17, 2023/Orthopaedics
16 Hand and Wrist Exercises To Help Ease Arthritis Pain

Simple exercises like tendon glides and finger lifts can have a big impact

Trending Topics

Female and friend jogging outside
How To Increase Your Metabolism for Weight Loss

Focus on your body’s metabolic set point by eating healthy foods, making exercise a part of your routine and reducing stress

stovetop with stainless steel cookware and glassware
5 Ways Forever Chemicals (PFAS) May Affect Your Health

PFAS chemicals may make life easier — but they aren’t always so easy on the human body

jar of rice water and brush, with rice scattered around table
Could Rice Water Be the Secret To Healthier Hair?

While there’s little risk in trying this hair care treatment, there isn’t much science to back up the claims