Back injections, such as epidural steroid injections or facet joint injections, are a common non-surgical option used to manage chronic back and leg pain. These procedures deliver anti-inflammatory medication and often a local anesthetic directly to the source of pain, typically a nerve root or an inflamed joint. Knowing what to expect in the hours and days after the procedure helps patients maximize therapeutic benefit and distinguish between normal recovery sensations and signs that require medical attention.
Immediate Post-Procedure Care
The first 12 to 24 hours following a back injection require careful adherence to specific guidelines. Driving is prohibited immediately after the procedure because local anesthetics may cause temporary leg weakness or numbness. Since the medication can affect motor function, it is unsafe to operate a vehicle until the effects have fully worn off, generally the day after the injection.
Patients should rest and avoid strenuous activities for the remainder of the day, including heavy lifting, bending, or twisting. Limit walking or sitting to brief periods, such as 10 to 20 minutes at a time. Avoid baths or submerging the injection site for at least 24 hours, though showering is permissible.
Patients should continue taking most prescribed medications unless instructed otherwise by the physician. If blood thinners or aspirin were temporarily stopped, the doctor will provide instructions on when to safely resume them. Applying an ice pack to the injection site for up to 20 minutes at a time can help reduce local soreness and discomfort.
Expected Temporary Sensations
Experiencing certain physical sensations after a back injection is normal. Many patients feel mild soreness or tenderness at the injection site, which can be managed with ice and over-the-counter pain relievers. This localized discomfort typically resolves within a day or two.
The local anesthetic may cause temporary numbness, tingling, or weakness in the legs or feet, which subsides completely within a few hours. A temporary increase in the original pain, often called a “pain flare,” is also common. This flare occurs as the anesthetic wears off before the steroid reduces inflammation, and it usually lasts for 24 to 48 hours.
Temporary systemic side effects related to the corticosteroid medication may occur, including a mild headache, facial flushing, or difficulty sleeping. Diabetic patients should closely monitor a transient rise in their blood sugar levels. These sensations are a normal response to the medication and typically pass quickly.
Monitoring Treatment Effectiveness and Warning Signs
The therapeutic effect of the injection is not immediate. The quick, initial pain relief patients feel is due to the local anesthetic, which wears off in a matter of hours. Once the anesthetic is gone, the original pain may return, or the temporary pain flare may begin.
The corticosteroid component is responsible for long-term relief and requires time to work as an anti-inflammatory agent. Significant pain reduction usually begins three to seven days after the procedure, but it can take up to two weeks to reach its full potential. Patients are often asked to track their pain scores to monitor effectiveness.
While most post-procedure sensations are benign, certain symptoms require immediate medical attention. Signs of infection, such as a fever of 101.4°F or higher, shaking chills, or worsening redness, swelling, or pus-like drainage at the injection site, should be reported immediately. A severe headache that is worse when sitting or standing and improves when lying flat may indicate a cerebrospinal fluid leak.
New or rapidly worsening weakness, numbness in the legs, or the loss of bladder or bowel control are signs of potential nerve compression. These symptoms require emergency care.