Do Spine Injections Hurt? What a Spine Injection Feels Like
Do spinal injections hurt? It is one of the most common questions people ask before a spine injection. Most people feel a quick sting and some pressure, not sharp pain. This guide explains what you may feel, step by step and by type of injection, plus how numbing and sedation work and what is normal afterward.
Quick Answer: Do Spinal Injections Hurt?
- Most people feel a quick sting from the numbing medicine, then pressure.
- Some feel a brief zing or their familiar pain as the medicine reaches the sore area.
- The skin is numbed first, and X-ray (fluoroscopy) guidance is used to place the needle.
- The injection itself usually takes minutes.
- Sedation ranges from none (numbing only) to light sedation to anesthesia care, chosen with you.
- Some soreness for a few days can happen.
- Fever, a severe headache when sitting up, new weakness, or bladder or bowel changes: call right away or get emergency care.
Do Spinal Injections Hurt? What You May Feel Step by Step
- Positioning: you usually lie face down on a padded table. Pillows help you get comfortable.
- Cleaning: the skin is cleaned with a cold soap. Many people notice the cold more than anything else.
- Numbing: a small needle numbs the skin. This is the quick sting most people remember. It may burn for a few seconds.
- Needle placement: you may feel pressure or pushing, but the numbing medicine dulls sharp pain. The doctor uses X-ray to guide the needle.
- Contrast dye: a small amount of dye confirms the needle is in the right spot. Most people feel little or nothing.
- Medicine: some feel pressure, warmth or a brief zing. Others feel very little.
Some people feel lightheaded or faint during or right after a procedure. This is called a vasovagal reaction. It was the most common short-term event in large studies, and it usually passes quickly with rest [Source] [Source].
How Spine Injections Feel by Procedure
Epidural Steroid Injection
An epidural steroid injection places medicine near irritated nerve roots. It can be given between two vertebrae (interlaminar), through the side opening where a nerve exits (transforaminal), or near the tailbone (caudal). Expect the numbing sting, then pressure. A short burst of familiar leg or arm pain can happen with a transforaminal approach, because the needle is placed close to the nerve.
Selective Nerve Root Block
A selective nerve root block targets one nerve root. Because the medicine is placed right next to the nerve, a brief zing down the arm or leg is common. That feeling can help show which nerve is causing your pain.
Facet and Medial Branch Blocks
A facet joint block treats the small joints on the back of the spine. A medial branch block numbs the tiny nerves that carry pain from those joints. Both usually feel like a sting, then deep pressure or an ache. The needles are small and the injections are quick.
A medial branch block is a test. Afterward, you will be asked to do things that normally hurt and track how your pain changes. Heavy sedation can make that harder to judge, so your doctor may suggest little or no sedation for this test.
SI Joint Injection
A sacroiliac (SI) joint injection goes into the joint where your spine meets your pelvis. Many people feel pressure or a deep ache in the buttock as the medicine goes in. If the injection is used as a test, you may also be asked to track your pain afterward.
Radiofrequency Ablation
Radiofrequency ablation (RFA) uses heat to quiet the nerves that carry joint pain. It usually follows positive medial branch blocks. The skin is numbed, and the area is numbed again before the heat stage. Before that, the doctor may test the needle position, and you may feel tingling or pressure. Some people have soreness, burning or a sunburn-like feeling for a while afterward.
Numbing and Sedation: Will I Be Awake?
Every spine injection starts with numbing medicine in the skin. Beyond that, sedation is a range, and the plan is chosen with you before the procedure day:
- No sedation: you stay fully awake with local numbing medicine only. You can tell the doctor what you feel as it happens.
- Light sedation: a medicine such as midazolam (Versed) helps you relax. Most people stay awake but calm.
- Monitored anesthesia care: an anesthesia professional gives a medicine called propofol and watches your breathing, heart rate and oxygen the whole time. You will be very sleepy or asleep.
The right choice depends on the procedure, your health and how nervous you feel. For some test blocks, such as a medial branch block, your doctor may suggest little or no sedation so the test result is accurate.
If you get sedation, you will need a driver to take you home. Your prep sheet will cover the full day-of checklist.
Researchers are also studying virtual reality headsets as a way to ease pain and worry during epidural injections [Source]. This is still research and is not a standard part of care.
How Safe Are Spine Injections?
Large studies from academic spine centers found that serious problems right after image-guided spine injections were rare. Minor events, such as feeling faint, were more common [Source] [Source]. Common delayed effects after a transforaminal epidural include a short pain flare, soreness at the site, headache, facial flushing and trouble sleeping [Source].
Rare but serious problems, such as stroke, vision loss or spinal cord injury, have been reported after epidural steroid injections. Experts have published safety steps to lower these risks, such as image guidance and careful choice of medicine [Source]. The FDA has not approved steroid medicines for epidural use, so this is an off-label use, and the FDA requires a warning about these rare risks on the labels [Source]. Talk with your doctor about the benefits and risks for you.
Dr. Amit Sharma & our minimally invasive pain & spine team.
After the Injection: Soreness and What Is Normal
Soreness at the injection site, or a short flare of your usual pain, is common and usually settles [Source]. Steroid medicine may cause flushing or trouble sleeping for a short time [Source]. It can also raise blood sugar, so follow the advice in preparing for a spine injection if you have diabetes.
Numbing medicine wears off within hours. Steroid medicine, when it helps, may take several days to work. If relief fades quickly, read why an epidural may only last a few days.
Tips to Make Spinal Injections Easier
- Ask questions ahead of time. In one study, patients who got written information before a spinal steroid injection knew more about it and were more satisfied [Source].
- Tell the team if you feel nervous. They can talk you through each step.
- Breathe slowly and let your muscles relax on the table.
- Eat and take medicines as instructed. Follow the prep sheet you are given.
- Wear loose clothing and leave jewelry at home.
When to Call or Seek Emergency Care
Call 911 or go to the emergency room now for new or spreading weakness, numbness in the groin or inner thighs, new bladder or bowel problems (cauda equina syndrome signs), vision changes, sudden numbness or weakness on one side, a seizure, or a sudden severe headache [Source].
Call the office for fever or chills, redness or drainage at the site, a severe headache that gets worse when you sit up, or pain that keeps getting worse. Call 631-310-0000.
Getting a Spine Injection at SpinePain Solutions
At SpinePain Solutions, Dr. Amit Sharma, Chief, Division of Pain Medicine at Good Samaritan University Hospital, sees patients at our Bay Shore, Commack and Farmingdale offices (see office locations). Care usually starts with physical therapy, activity and medicines. When an injection fits, you will learn what to expect, how numbing works and your sedation options before the procedure day. Learn more about spine injections. Call 631-310-0000.
Frequently Asked Questions
Do spinal injections hurt?
Most people feel a quick sting from the numbing medicine, then pressure rather than sharp pain. Some people feel a brief zing or their usual pain for a moment. Everyone is different, so tell the team how you are doing during the procedure.
When should I call the doctor or go to the ER after a spine injection?
Call the office for fever, chills, redness or drainage at the site, or a severe headache that gets worse when you sit or stand. Call 911 or go to the ER for new weakness, numbness in the groin or inner thighs, new bladder or bowel problems, vision changes, sudden numbness or weakness on one side, a seizure, or a sudden severe headache.
What does an epidural steroid injection feel like?
Many people feel a sting from the numbing shot, then pressure as the needle is guided into place. As the medicine goes in, some feel pressure, warmth or a short burst of their usual leg or arm pain.
Are you awake for a spine injection?
It depends on the sedation plan you and your doctor choose. Some people stay awake with local numbing medicine only. Others get light sedation with a medicine such as midazolam (Versed), or monitored anesthesia care, where an anesthesia professional gives propofol and watches you closely.
Why might I feel a brief zing or my usual pain during the injection?
The medicine is placed near an irritated nerve or joint. When it gets close, you may feel a short zing or your familiar pain. This usually fades quickly. Tell the doctor what you feel, because it can help guide the procedure.
Does a medial branch block hurt, and why might sedation be limited?
A medial branch block usually feels like a sting from the numbing medicine, then some pressure. This block is a test, and you will be asked to report how your usual pain changes afterward. Heavy sedation can make that report less reliable, so your doctor may suggest little or no sedation for this test.
How sore will I be after, and for how long?
Some soreness at the injection site or a short flare of your usual pain is common. How long it lasts varies from person to person. Ice and rest for the day often help. Call if pain keeps getting worse instead of settling.
What can I do to make the injection more comfortable?
Ask your questions before the day of the procedure, so you know what to expect. Tell the team if you feel nervous, and try slow, steady breathing. Wear loose, comfortable clothes.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Medical References
- Carr CM, Plastaras CT, Pingree MJ, et al. Immediate adverse events in interventional pain procedures: a multi-institutional study. Pain Med. 2016;17(12):2155-2161. doi:10.1093/pm/pnw051. PubMed.
- El-Yahchouchi CA, Plastaras CT, Maus TP, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: a multi-institutional study. Pain Med. 2016;17(2):239-249. doi:10.1111/pme.12896. PubMed.
- Plastaras C, McCormick ZL, Garvan C, et al. Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J. 2015;15(10):2157-2165. doi:10.1016/j.spinee.2015.05.034. PubMed.
- Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122(5):974-984. doi:10.1097/ALN.0000000000000614. PubMed.
- Racoosin JA, Seymour SM, Cascio L, Gill R. Serious neurologic events after epidural glucocorticoid injection: the FDA’s risk assessment. N Engl J Med. 2015;373(24):2299-2301. doi:10.1056/NEJMp1511754. PubMed.
- Coudeyre E, Poiraudeau S, Revel M, et al. Beneficial effects of information leaflets before spinal steroid injection. Joint Bone Spine. 2002;69(6):597-603. doi:10.1016/s1297-319x(02)00457-8. PubMed.
- Cohen SP, Doshi TL, Munjupong CS, et al. Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections. Lancet Reg Health Southeast Asia. 2024;27:100437. doi:10.1016/j.lansea.2024.100437. PubMed.
