Epidural Steroid Injections may help selected spine-related nerve pain when symptoms involve sciatica, radiating arm or leg pain, disc herniation, spinal stenosis, or irritated spinal nerves.
Learn how Dr. Siefferman performs epidural injections to help reduce inflammation, relieve nerve pain, and improve function for patients with spine-related pain.
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Hi, I’m Dr. Jason Siefferman, Medical Director at Manhattan Pain Medicine and Interventional Pain Specialist. Epidural injections are one of the more frequent procedures we do because disc herniations are common. It’s important to know that not all epidurals are the same. It really depends on the intention of the epidural. What do we want to accomplish with the epidural, because many different things can be done with the epidural?
First of all, an epidural just means that it’s an injection within the space between the thecal sac, which holds the nerves in the spine, and the bony spinal canal. This is the space where, if a disc herniates, it pushes into the space and engages with the nerve root. This is also a space where scar tissue will build up from recurrent disc herniations or from spine surgery.
With an epidural, based on our approach, we can target that disc-nerve interface from a variety of directions. We can also use a variety of different medications to accomplish different ends. So based on what your needs are, if an epidural makes sense, we will discuss how that epidural could be used to accomplish the specific mechanical outcome that we want to achieve.
To recap, we can do a lot with epidurals. There’s a lot of different ways to do epidurals, and there’s a lot of different things we can accomplish with epidurals. If it makes sense based on your situation, we’ll talk through the range of options. Each provider approaches this methodologically differently. Almost like Michelin-star chefs will have a different recipe for apple pie. And not everyone’s apple pie is going to taste the same.
When we evaluate a patient, I really want to understand: what is it that we need to accomplish with an epidural, and how can I craft that epidural very specifically mechanically to accomplish what I want it to accomplish? Interesting add-ons with an epidural may include scar-dissolving medications. For a patient who’s had a prior surgery, I may do what’s called an epidurolysis procedure. This is where I can use a catheter to target areas of scar tissue and inject medication specifically to dissolve that scar tissue. Generally, this produces a more durable result than just popping steroid into the space.
We know with epidural steroid injections, the steroid is only effective in new-onset radiculopathy, meaning a new disc herniation causing sciatica-type pain. If this is an old disc herniation and there are adhesions from that disc sticking, or if there’s spinal stenosis, there’s actually no role for the steroid. There’s no benefit from the steroid in that situation, and just high-volume fluid, local anesthetic, and contrast by itself may be enough.
So when we’re looking at a patient who’s having any kind of nerve entrapment or pain from the disc-nerve interface in the back, we figure out, based on the imaging and based on their exam, what approach, what technique, what contents, and what volume are going to be the most effective for that patient.
Epidural injections are targeted spine procedures used to evaluate or reduce selected nerve-root-related pain. They may be considered when pain is linked to irritated or inflamed spinal nerves, disc herniations, sciatica, spinal stenosis, or radiating neck, back, arm, or leg pain.
At Manhattan Pain Medicine, epidural injections NYC care begins with diagnosis-first evaluation. The goal is to determine whether pain is truly coming from a spinal nerve root or whether another generator may be involved, such as facet joints, the sacroiliac joint, hip, pelvic floor, peripheral nerves, inflammatory disease, hypermobility-related mechanics, or centralized pain.
MPM specialists evaluate whether an epidural injection may be appropriate by reviewing the patient’s symptoms, pain distribution, neurological findings, imaging, prior treatments, medication history, and safety factors. Epidural injections are most relevant when symptoms suggest spinal nerve irritation, such as radiating arm pain, radiating leg pain, sciatica, numbness, tingling, or nerve-root-related pain.
MPM also evaluates whether pain may be coming from disc herniation, spinal stenosis, spondylosis, spondylolisthesis, scoliosis, Tarlov cyst-related symptoms, pelvic floor dysfunction, endometriosis overlap, SI joint dysfunction, facet-mediated pain, peripheral nerve pain, or another condition.
Patients often search for epidural injections in Manhattan when back pain, neck pain, sciatica, arm pain, leg pain, numbness, tingling, disc herniation, or spinal stenosis has not improved with medication, physical therapy, activity modification, chiropractic care, imaging-based evaluation, or prior injections.
MPM approaches epidural injections as targeted, image-guided procedures within a broader spine pain pathway. Epidural injections may reduce inflammation around irritated spinal nerves, but they do not repair discs, reverse spinal stenosis, or cure chronic spine pain. The most important step is determining whether the patient’s symptoms, exam findings, and imaging support an epidural target. If the pain is coming from another generator, another treatment may be more appropriate.
Epidural injections fit within MPM’s Musculoskeletal issues and Complex Chronic Pain expertise because spine-related pain often involves overlapping structural, nerve, inflammatory, pelvic, and nervous system factors. A patient may have a disc herniation, sciatica, spinal stenosis, spondylosis, scoliosis, spondylolisthesis, pelvic floor dysfunction, pelvic pain overlap, nerve irritation, or chronic pain sensitization.
MPM uses epidural injections as one possible tool within a coordinated care plan. Depending on the diagnosis and response, care may also include medication management, physical therapy, targeted spine procedures, SI joint injection, peripheral nerve blocks, epidural lysis of adhesions, spinal cord stimulation, surgical evaluation, or specialist coordination when appropriate.
Before an epidural injection, MPM reviews the suspected pain generator, imaging, neurological findings, medications, allergies, bleeding risk, medical history, risks, alternatives, and post-procedure instructions. Epidural injections are typically performed with image guidance to support accurate placement and procedural safety.
During the procedure, medication is placed into or near the epidural space around the targeted spinal nerves. Patients may feel pressure, brief discomfort, temporary numbness, soreness, or a short pain flare after the injection. Relief may occur quickly if local anesthetic is used, while steroid-related improvement may take longer. Some patients experience temporary relief, some have longer improvement, and some do not respond. MPM reviews the response to determine whether the target was clinically meaningful and what next step should be considered.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
An epidural injection is a spine procedure that places medication into or near the epidural space around spinal nerves. It may be considered when pain appears related to irritated or inflamed spinal nerve roots. At MPM, epidural injections are recommended only after evaluating whether symptoms, exam findings, and imaging support a nerve-root-related pain pattern.
An epidural steroid injection uses corticosteroid medication, often with local anesthetic, to help reduce inflammation around irritated spinal nerves. It may be considered for selected cases of sciatica, disc herniation, spinal stenosis, cervical radiculopathy, lumbar radiculopathy, or radiating arm or leg pain. It does not repair a disc, reverse stenosis, or cure chronic spine pain.
Epidural injections are intended to reduce inflammation around irritated spinal nerves. When nerve root inflammation is contributing to pain, reducing that inflammation may help decrease radiating pain, numbness, tingling, or nerve-related symptoms for a period of time. Relief varies by diagnosis, anatomy, medication used, and patient response.
Epidural injections may be considered for selected cases of sciatica, disc herniation, spinal stenosis, radiculopathy, nerve root irritation, radiating leg pain, radiating arm pain, neck pain with arm symptoms, or back pain with leg symptoms. They may not be appropriate when pain is primarily facet-mediated, SI joint-related, hip-related, muscular, pelvic floor-related, peripheral nerve-related, inflammatory, or centrally amplified.
Epidural injections may help selected patients with sciatica when symptoms are related to irritation or inflammation of a spinal nerve root. This may occur with a disc herniation, spinal stenosis, or other spine-related nerve compression. If leg pain is caused by SI joint dysfunction, hip pathology, piriformis-related pain, pelvic mechanics, or peripheral nerve entrapment, another treatment may be more appropriate.
Epidural injections may help selected patients when a herniated disc irritates or inflames a nearby spinal nerve root. The goal is to reduce nerve-related inflammation and pain, not to repair or remove the herniated disc. MPM evaluates whether imaging findings match the patient’s symptoms before recommending an epidural injection.
Epidural injections may be considered for selected spinal stenosis patients, especially when nerve compression or inflammation contributes to radiating arm or leg symptoms. Relief may be temporary and varies by patient. Epidural injections do not reverse stenosis. Some patients may need medication management, rehabilitation, activity modification, spinal cord stimulation evaluation, or surgical consultation depending on severity and function.
Epidural injections may help selected patients with neck and arm pain when symptoms suggest cervical nerve root irritation. This may occur with disc herniation, foraminal narrowing, or spinal stenosis. If pain is mainly muscular, facet-related, shoulder-related, peripheral nerve-related, or headache-related, another treatment may be more appropriate.
Epidural injections are not a general pelvic pain treatment. They may be considered only when pelvic-region symptoms appear related to spine or nerve root involvement. Pelvic pain can also come from pelvic floor dysfunction, pudendal neuralgia, endometriosis, pelvic dystonia, SI joint dysfunction, hip pathology, peripheral nerves, or centralized pain. MPM evaluates these possibilities before recommending an epidural injection.
Interlaminar epidural injections place medication into the epidural space through the back of the spine. Transforaminal epidural injections target the area near a specific nerve root as it exits the spine. Caudal epidural injections access the epidural space through the lower sacral region. The best approach depends on diagnosis, anatomy, pain distribution, imaging, prior surgery, and safety factors.
Epidural injections may be therapeutic, diagnostic, or both. A therapeutic injection is intended to reduce inflammation and symptoms for a period of time. A diagnostic response may help confirm that a specific nerve root or spinal level is contributing to pain. MPM reviews the timing, location, and degree of relief to guide next steps.
Epidural injections are typically performed with image guidance, such as fluoroscopy or CT, depending on the procedure and clinical context. Image guidance helps support accurate placement and procedural safety. It does not guarantee relief, but it helps confirm the intended target and supports safer injection planning.
Relief varies by patient, diagnosis, medication used, severity of nerve irritation, and underlying condition. Some patients experience relief for days or weeks, while others may have longer improvement. Some patients do not respond. Temporary relief can still be useful when it helps confirm that the targeted nerve root or spinal level is clinically relevant.
The number of epidural injections depends on diagnosis, response, medical history, steroid exposure, safety factors, and treatment goals. Repeated steroid injections are not appropriate for every patient and should be limited based on clinical judgment. MPM reviews the risks and benefits before recommending repeat injections.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar, steroid-related side effects, dural puncture headache, nerve irritation, vascular injury, local anesthetic toxicity, incomplete relief, temporary relief only, or no relief. Rare serious neurologic complications have been reported. MPM reviews safety factors before treatment.
Epidural injections may not be appropriate when symptoms do not match a nerve-root-related pain pattern, when another pain generator is more likely, or when safety risks outweigh potential benefits. They may also need to be delayed or avoided with active infection, uncontrolled bleeding risk, certain medication concerns, unstable neurological symptoms, or urgent red flags. MPM evaluates these factors before recommending treatment.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering epidural injections in NYC for sciatica, disc herniation, spinal stenosis, radiating neck pain, back pain, arm pain, leg pain, numbness, tingling, or complex spine-related nerve pain, MPM can help determine whether this treatment may be appropriate. Your evaluation will consider your symptoms, imaging, exam findings, prior care, safety factors, and broader care goals before any recommendation is made.
Epidural injections are targeted spine procedures used to evaluate or reduce selected nerve-root-related pain. They may be considered for sciatica, radiating leg pain, radiating arm pain, disc herniations, spinal stenosis, cervical radiculopathy, lumbar radiculopathy, or other spine-related nerve irritation patterns.
At Manhattan Pain Medicine (MPM), epidural injections NYC care begins with diagnosis-first evaluation. The goal is to determine whether the patient’s symptoms, imaging, exam findings, and treatment history support an epidural target before recommending the procedure.
An epidural steroid injection places anti-inflammatory medication into the epidural space around spinal nerves. The purpose is to reduce inflammation around an irritated nerve root and potentially reduce radiating pain. Local anesthetic may also be used, which can provide temporary numbing and diagnostic information.
Epidural injections may help selected patients with pain traveling from the neck into the arm or from the lower back into the leg. They are not designed to repair a herniated disc, reverse spinal stenosis, correct scoliosis, or cure chronic spine pain. Their role depends on whether the patient’s pain pattern is truly nerve-root-related.
Back, neck, pelvic, arm, or leg pain can come from several structures. A patient may have pain from a disc, spinal nerve root, facet joint, SI joint, hip, muscle, ligament, pelvic floor, peripheral nerve, inflammatory disease, Tarlov cyst-related symptoms, endometriosis overlap, or central sensitization. Some patients have more than one contributor at the same time.
This is why MPM does not treat epidural injections as a default answer for spine pain. The evaluation focuses on symptom location, radiation pattern, neurological findings, imaging correlation, prior treatment response, and safety factors. The correct target matters more than simply receiving an injection.
Sciatica often refers to pain that travels from the lower back or buttock into the leg. It may occur when a spinal nerve root is irritated or inflamed. In selected cases, a lumbar or caudal epidural injection may help reduce nerve-related inflammation and improve symptoms for a period of time.
However, leg pain is not always caused by spinal nerve root irritation. SI joint dysfunction, hip pathology, piriformis-related pain, pelvic mechanics, peripheral nerve entrapment, vascular conditions, or centralized pain can sometimes create similar symptoms. MPM evaluates these possibilities before recommending an epidural injection.
Cervical epidural injections may be considered when neck pain is associated with radiating arm pain, numbness, tingling, or nerve-root-related symptoms. This can occur when a cervical disc herniation, foraminal narrowing, or spinal stenosis irritates a nerve root.
If symptoms are mainly caused by facet joints, muscle tension, shoulder pathology, peripheral nerve entrapment, headache disorders, or cervical dystonia, an epidural injection may not be the best target. MPM evaluates the full clinical picture before selecting a treatment approach.
Different epidural approaches may be used depending on the diagnosis and anatomy.
Interlaminar epidural injections place medication into the epidural space through the back of the spine. Transforaminal epidural injections target the area near a specific spinal nerve root as it exits the spine. Caudal epidural injections access the epidural space through the lower sacral region and may be considered in selected lower back or leg pain patterns.
The best approach depends on the patient’s symptoms, imaging, prior surgery, anatomy, safety factors, and treatment goals.
Epidural injections are often considered when inflammation around an irritated spinal nerve may be contributing to pain. Epidural lysis of adhesions, sometimes associated with a Racz catheter, may be considered in selected cases when scar tissue or adhesions are suspected to contribute to persistent nerve pain, often after prior surgery or prolonged symptoms.
Spinal cord stimulation is a more advanced neuromodulation option that may be considered for selected chronic nerve-related pain patterns when conservative care and less invasive procedures have not provided enough relief. MPM uses diagnosis, imaging, prior treatment response, and functional goals to determine whether any of these options should be discussed.
Relief after an epidural injection can provide useful information. If pain improves in the expected region, the response may support the targeted spinal nerve or level as clinically meaningful. If relief is incomplete, very short-lived, or absent, another pain generator may be involved.
MPM reviews the timing, location, and degree of relief after the procedure. This helps determine whether to repeat an injection, consider another target, adjust medication management, continue rehabilitation, evaluate for epidural lysis of adhesions, discuss spinal cord stimulation, or coordinate surgical evaluation when appropriate.
Epidural injections are medical procedures and should be selected carefully. Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar, steroid-related side effects, dural puncture headache, nerve irritation, vascular injury, local anesthetic toxicity, incomplete relief, temporary relief only, or no relief. Rare serious neurologic complications have been reported with epidural corticosteroid injections.
Patients should seek urgent evaluation for new or worsening weakness, bowel or bladder dysfunction, saddle anesthesia, fever, severe back pain after trauma, unexplained weight loss, cancer-related red flags, severe infection symptoms, sudden severe headache after injection, chest pain, shortness of breath, severe allergic reaction, or rapidly worsening symptoms.
For selected patients, epidural injections may be an important part of a diagnosis-first spine pain plan. MPM’s role is to determine whether the pain pattern, imaging, exam, and safety profile support an epidural injection and how the response should guide the next step in care.
