Spine injections help a lot of people with back, neck, arm and leg pain. A question we hear often in our New Jersey offices is simple: how many epidurals is too many?

The answer starts with a surprise for many patients. Not every shot in the back is an epidural, and the different types follow different rules.

Not all injections are the same

“Epidural” has become a catch-all word. Patients often use epidural, cortisone shot and nerve block to mean the same thing. In fact, these words can describe several different procedures, each aimed at a different source of pain:

• Epidural steroid injection. Anti-inflammatory steroid medicine is placed in the epidural space, near an irritated nerve root. It is meant for radicular pain, meaning pain that travels down the leg (sciatica) or down the arm.
• Medial branch block. Numbing medicine is placed next to the small nerves that carry pain from the facet joints, the small joints at the back of the spine. It is often used as a test. If the pain eases for a few hours, the facet joints are likely a pain source.
• Rhizotomy (radiofrequency ablation). If a medial branch block works, heat is used to quiet those same small nerves. Relief often lasts many months, and the procedure can be repeated if the nerves recover.

So when someone says “I have had five epidurals,” it helps to know which procedures those were. A mix of tests and treatments is very different from five steroid injections in the same spot. Ask your pain management physician for the name of each procedure, or check your visit notes.

How many epidural steroid injections are reasonable?

For true epidural steroid injections, many spine physicians aim for about three or four per year in the same area of the spine, spaced several weeks apart. Your own doctor may set a different limit based on your health and how you have responded.

Just as important as the number is the result. A repeat injection makes the most sense when the last one clearly helped. If it gave strong relief that lasted months, another one later can be a reasonable choice. If it gave little or no relief, simply repeating it is less likely to work, and it is a good time to talk with your doctor about next steps.

Steroids are useful medicines and epidurals are generally safe, but side effects can add up with frequent use. These include a short-term rise in blood sugar, which matters for people with diabetes, possible effects on bone strength over time, and rare risks such as infection or bleeding. Spacing injections out helps keep the benefits high and the risks low.

Signs it may be time for a surgeon’s opinion

Injections and surgery are not rivals. They are tools on the same team, and many of our patients see both a pain management specialist and a surgeon. A surgical opinion does not mean you need surgery. Most people with back pain never do.

It can be helpful to have a spine surgeon review your case if:

• Each injection helps for a shorter time than the one before
• You have had several injections over a year or more and the pain keeps coming back
• Leg or arm pain is limiting your work, sleep or daily life
• You notice weakness, numbness that is spreading, or trouble walking
• You want to understand all of your options before deciding on next steps

One important note: new loss of bladder or bowel control, or numbness in the groin area, is an emergency. Go to the nearest emergency room right away.

What a second opinion looks like

A spine surgery second opinion starts with a careful review of your MRI, your symptoms and the treatments you have tried, including which injections you have had. Dr. Kris Radcliff is a fellowship-trained spine surgeon and Professor at Thomas Jefferson University who has performed thousands of surgeries.

Sometimes the advice is to keep going with the current plan. Sometimes it is a different nonsurgical option. For some people with a herniated disc or spinal stenosis, a minimally invasive or motion-preserving procedure may be worth discussing. The goal is a clear picture so you can make a confident choice.

We see patients in Somers Point, Cherry Hill and Brick, New Jersey, and we work closely with referring pain management physicians.

Frequently asked questions

Is a nerve block the same as an epidural?

Not always. An epidural steroid injection treats nerve pain that travels into the leg or arm. A medial branch block numbs small nerves to the spine’s facet joints, often to find out whether those joints are causing back or neck pain.

How many epidural steroid injections can I have in a year?

Many doctors suggest about three or four per year in the same area, spaced several weeks apart. Your doctor may recommend a different number based on your health and how well past injections worked.

What if my injection did not work?

If an injection gave little or no relief, repeating the same one is less likely to help. Talk with your doctor about the cause of your pain and other options, which may include a spine surgeon’s review.

Get a review of your MRI

If you have had several injections and are wondering what comes next, we are glad to help. Call 609-800-3472 or send your MRI for a review.

This article is for general education and is not medical advice. Please talk with your own doctor about your care.