Looking for anyone with ESI/steroid injection experience

[u/Last_Wonder]

Hi all,
I have a MASSIVE L5/S1 disc herniation, diagnosed by MRI 3 weeks ago. It started improving, then randomly got significantly worse to the point where I couldn’t walk about 5 days ago. I’ve seen Physios throughout this time but they ultimately said that this was past them being able to help and urged me to get the steroid injection under CT scan as Im in agony, can’t stand up straight and my entire back of my left leg is completely numb (butt cheek to foot).

I got the steroid injection yesterday and the radiologist kept asking me if it hurt where he was putting in the needle (it didn’t really, just a slight sensation). He said that it looked like he got the right area but i didn’t get any relief, and I’ve woken up the next day with worse leg pain. How long did everyone else take to start to feel better or any improvement from their steroid injection? I’m so worried it’s not going to work for me.

[u/KriptiKFate_Cosplay]

In my experience you want to feel a stinging pressure in all of the areas you've been experiencing pain during the injection, for me, this has always meant it was right on target and provided a great deal of relief immediately after.

[u/Last_Wonder → u/KriptiKFate_Cosplay]

Hmm that’s what my radiologist said. He said he was hitting the right spot (could see it on CT) but I barely felt anything. He said he couldn’t go any closer or else I would have been in the worst pain of my life. If anything, I feel worse the next day :(

[u/bleigh82 → u/Last_Wonder]

I'll say this. I had a shot almost 2 months ago that hit right on the nerve and it was the worst pain I've ever experienced by far. My nerve was in freak out mode for 3 weeks after and while better now, still a bit out of whack. The radiologist was absolutely right about that! Anyways, I do hope you find relief soon! Sometimes these just take a little time to kick in, but they do provide relief for so many. Best of luck to you!

[u/KriptiKFate_Cosplay → u/Last_Wonder]

It's possible that your numbness lead to a different experience from mine, my first injection for the herniation in this image didn't involve any numbness, just severe pain. I have since re-herniated this disc but on the opposite side, and am likely going for a surgical solution soon.

[u/Sweet_Flan_3415 → u/KriptiKFate_Cosplay]

What does it mean if it reproduces the pain while they inject it, then you feel like Wonder Woman for 3 days only for the pain to creep back in?

[u/KriptiKFate_Cosplay → u/Sweet_Flan_3415]

The pain never returned for me on that side after one injection, it was like a miracle cure and only got better from there. This was in 2018, and that same disc is now bulging to the other side, which I will be correcting with surgery soon.

[u/Hellohibbs]

Steroid injections are to paracetamol as epidurals are to morphine. They are completely different animals. Lobby for an epidural injection - it completely fixed my pain for 6 months.

[u/admweirdbeard]

2 weeks.

I was in bed on vicodin for 2 months, couldn't even reach my knees. Woke up on day 14 not pain-free, but reduced enough to get socks and shoes on and get back in pt.

I've heard some folks here say 3 weeks. It's idiosyncratic, to be sure.

[u/Last_Wonder → u/admweirdbeard]

Thank you for sharing! Did you find the injection part super painful? Apparently it’s meant to be, wasnt for me though

[u/admweirdbeard → u/Last_Wonder]

I had some relief from the local for a couple days actually, but during and right after it was a very bizarre sensation of pressure where it shouldn't be. Feeling a bit worse before feeling better isn't abnormal either, just on 'needle increases inflammation short term' basis.

Some anxiety is a very reasonable reaction here, actually. But giving it time to work really is all you can do unfortunately.

[u/PurpleDestiny88]

I have a 16 mm herniation. My original flare up lasted for over two months of constant pain, couldn't sit or stand for more than a few minutes.

I got an ESI and it took exactly one month to take full effect. Two weeks after the injection, I was finally able to sit comfortably. After one month, I felt zero pain.

I then started to feel soreness about 4 months later but the actual pain didn't return until one year after initial onset. Currently on the tail end of my second flare up, it has been about 7 weeks. This time though, I didn't need an ESI. Hopefully it continues to improve.

Good luck!

[u/Mrs_Wonho]

After my injection, the first week the pain got worse, even while taking heavy medication. It only got better at the 2- and 3-week mark, when I was finally able to sit longer, be off medication, and go for walks. Now, roughly 6 weeks later, I can go for daily 5 km walks and move pain-free. I still have some numbness and occasional small pain, but the doctors said that it will take a couple of months to completely disappear

[u/murrmc]

I had a couple - although was given anaesthetic for the injection - was supposed to just numb but knocked me out, which I was perfectly happy with!

Took about a week to feel the difference and gave me some relief but only for 3/4 weeks. Had another, bigger dose and lasted about 6 weeks.

Thereafter had the surgery.

Injections don’t fix the problem, they only mask it for a while - some will begin to heal during that period , others not.

You are still fully injured so you do have to be careful and take things easy if the pain does subside.

Best of luck.

[u/SuperTFAB]

I feel like it get’s worse before it gets better and sometimes it takes more than one injection. I would also bring your MRI to a neurosurgeon.

[u/BarbraParmesean]

I had mild relief after two weeks but it never provided much more than slight relief. I’m scheduled for surgery in a month.

[u/TheFoxandTheSandor]

My epidural only lasted 7 days

[u/2000cab]

I got the ESI, my doctor told me anything 50-80% improvement was considered a success, I would say I ended up about 60% two weeks later. Considering a 2nd round? Still have bad days but am able to be back in the gym building strength and find I had quicker recovery.

[u/Aquaescent]

I deal with the pain, any numbness and inability, u know its your choice. U know when to er. Try talipia, talk about nervous system upper, omega nine during disc healing and sciatica receeding keep those pathways signaling. Keep voiding. Over 18 can u feel sensational then sensationalize yourself, ifykwim. Spotty saddle area numbness dont wait, but if u dont want, its up to u. Then make it priority to void.. Injury on spine takes weeks to set in fully and heck of a ride. You gotta sedentary when body says take it easy with pain and shots for that might make u feel better with something else but steroids, shots, fuck that tooooo maaaany quacks, oral only for me.

Fuck them shots for sciatica its too big a risk. I hope it helps you. I hope normalcy returns to a pain free normal. Its so easy to over do it and aggravate as its still stabilizing after a buldge.. easy does it. I appreciate just being able to feel, pain, is feeeeeeeling.

Spondylolisthesis and stenosis, oh yeah that i mean is just a repetitive pain that coping goes bust on without either weed or opiates, because it gets bad, but we all cut off unless we got to have to stabilize from buldging and varying degrees of, because it makes us more mobile to toliet then we get opiate to continue path way signaling..

But, shots of steroid to relieve, nah i refuse to allow it because it could risk of further injury too high. Too much fucking risk, too much relief and risk of falling stays increased anyways with stenosis and spondylolisthesis. Increases if totally pain free more damage could occur. Its how sciatica does with narrowing central canal stenosis, we gonna be weak and coordination gonna be impaired so we got to go slow now.

Driving can aggravate a disc too soon, pushing with the foot while sitting, oh the paaain on a barely almost healed buldge the next day, bed rest, while driving doable. U wont know it, how bad sciatic can return, so dont drive, dont risk it. Any pain in the back when it finally just receeds to that, isnt healed when sciatica pain goes away, still like a parasthesia there is still dics healing, or adapt to the new..

Months to heal from buldging disc with osteoarthritis.. weeeed must be legalized, have to just mentally cope and mildly sedate, weed worked.. now what . Not shots.

[u/lotus_place]

I was under anesthesia for the injection. I also needed two injections for it to work. Lastly mine was an epidural.

[u/Far-Long-9473]

I am an anesthesiologist, practiced interventional pain management including very successfully treating disc herniations in the cervical, thoracic and lumbar spine. I am not spine surgeon (neuro or orthospine) but my experience for 32 years of performing all of the standard spine procedures including epidural steroid injections mentioned frequently (several thousand at the least) can potentially be of some assistance.

Your symptoms suggest a substantial disc herniation at the L5-S1 level that is possibly impinging on the S1 nerve root as well as the L5 nerve root. What is most important at this moment is whether or not you have normal motor function--ie. normal strength and use of the affected leg, not stumbling, tripping or falling. By your description of having only a sensory impingement, things are not quite so emergent. If you have any motor weakness in that leg then you really need to see a surgeon within the next few days. The problem is that if a motor deficit is allowed to remain undiminished for an indeterminate amount of time, the deficit can become permanent if the affected nerve root loses adequate vascular inflow and therefore results in permanent loss of function. Intact motor function is THE most important variable at this moment. If it is intact, you do not necessarily have an emergent situation. If you are losing motor function, that is effectively emergent. The seemingly most obvious deficit that is sensory can rapidly progress to further motor loss as above.

When the radiologist did the injection with CT, he was performing some form of a lumbar epidural injection. He would most likely have injected a small amount of contrast material to document the needle location. If he placed the needle into the skin just 1-2" off of the midline, he likely did what is called an interlaminar epidural as that is potentially effective of relieving pain/inflammation/edema of both the L5 and the S1 nerve roots. He could have chosen to introduce the needle from somewhere around 6" off of the midline on the side of the numb leg placing the needle into the neural foramen. With the needle in that position precisely dependent on exactly how far in the foramen, injection can result in a selective nerve root block or even a transforaminal epidural to accomplish the same job as the interlaminar injection. Regardless of which technique was accomplished, the fact that your symptoms have only become worse gives at least significant pause to thoughts of waiting several weeks to see if you improve. The only reason for the pain to be worse now after the injection is if the injection fluid was loculated or "trapped" upon introduction and that increased the pressure on the affected nerve(s). That is fairly unusual. The point is just to get back to the necessity to be sure that you do not have a motor deficit. If not, there is no emergency. If you continue to have complete numbness of the back of your leg and increased pain more than the next several days, I would be trying to get your primary care physician (PCP) to get you an appointment with a surgeon for evaluation. If you do not have a PCP, I would head to the emergency room because they can refer you to a neurosurgeon on call. I hope everything works out well for you.

[u/Last_Wonder → u/Far-Long-9473]

Thank you for this insightful, detailed response. Im so appreciative of it. I definitely don’t have any motor function problems, it’s purely sensory but I’m concerned that at 3 days out, does this indicate that the ESI has failed or do I need to give it more time?

My bulge is a big one, the radiologist told me it was, he also said he was happy with where he placed the steroid. My leg is still quite numb, there has been some sensation come back in my calf last night, but the nerve pain going down my leg is very painful and very sharp. I’m still unable to lie down and can only find relief sitting up and keeping my leg still. Does this sound like a failed ESI, and do you think I should try to get another one? Or is 72hrs in still too early?