Can people with a herniated disc have an epidural?

From the Guidelines

Yes, people with a herniated disc can generally have an epidural, as epidural steroid injections are a common treatment option for herniated discs, delivering anti-inflammatory medications directly to the area of nerve irritation. According to the most recent and highest quality study, the 2025 BMJ guideline on commonly used interventional procedures for non-cancer chronic spine pain 1, there is a strong recommendation in favor of epidural injections for chronic low back pain due to disc disease. The procedure involves inserting a needle into the epidural space around the spinal cord, guided by fluoroscopy or CT imaging for accuracy, and typically contains a corticosteroid combined with a local anesthetic such as lidocaine or bupivacaine. Some key points to consider:

• Patients usually receive 1-3 injections over several weeks or months, with each session lasting about 15-30 minutes.
• Relief can begin within 2-3 days and may last weeks to months.
• However, not everyone is a candidate - those with infections, bleeding disorders, or certain allergies may need alternative treatments.
• The injections work by reducing inflammation around the compressed nerve root, decreasing pain signals and improving function.
• While epidurals can provide significant symptom relief, they don't fix the underlying disc herniation and are typically part of a comprehensive treatment plan that includes physical therapy. It's also worth noting that the American Society of Interventional Pain Physicians (ASIPP) comprehensive evidence-based guidelines from 2021 recommend in favor of fluoroscopically guided epidural injections, with or without steroids, for chronic spine pain associated with disc herniation, spinal stenosis, axial discogenic pain, and post-surgery syndrome 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Epidural Injections for Herniated Discs

• People with a herniated disc can have an epidural injection, as studies have shown that epidural steroid injections can be effective in reducing pain and alleviating symptoms associated with lumbar herniated discs 2, 3.
• Epidural injections have been found to have a reasonable success rate for alleviating radicular symptoms from lumbar herniated discs, with some patients able to avoid surgical treatment for up to 12-27 months 3.
• The effectiveness of epidural steroid injections can vary depending on the individual and the severity of their condition, with some studies showing that epidural injections may not be as effective as discectomy in reducing symptoms and disability associated with large herniations of the lumbar disc 4.

Safety and Efficacy

• Epidural steroid injections have been found to be a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation, with no apparent side effects reported in some studies 5.
• The use of epidural steroid injections in patients with severe, multilevel lumbar spinal stenosis has been found to be safe, with evidence suggesting that these injections can be performed safely even in this setting 6.
• However, the effectiveness of epidural injections can depend on various factors, including the size and location of the herniation, as well as the individual's overall health and response to treatment 2, 4.

Treatment Outcomes

• Studies have shown that epidural steroid injections can lead to significant reductions in pain and improvements in functional ability, with some patients experiencing long-term relief from symptoms 2, 3.
• In some cases, epidural injections may not provide complete relief from symptoms, and additional treatment options, such as discectomy, may be necessary 4.
• The use of epidural steroid injections as a treatment for herniated discs is supported by evidence from multiple studies, which suggest that these injections can be a useful adjunct to other treatment options, such as physical therapy and pain management 2, 3, 5, 4, 6.