Back Pain After an Epidural

Epidurals and epidural steroid injections are important pain relief treatments for childbirth, surgery, and back pain. However, if you experience lingering back pain after an epidural, you may worry that something is wrong. 

In this article, we’ll explore back pain after epidurals and when to seek professional medical care. 

What is an Epidural?

An epidural is an injection of steroid medication or a local anesthetic into the epidural space (the area surrounding the spinal nerves). It’s used to alleviate pain in various medical settings, including childbirth, some surgeries, post-op care, and chronic back pain treatment. 

There are two main types of epidurals: Epidural anesthesia and epidural steroid injections.

  • Epidural anesthesia provides a temporary loss of sensation by temporarily numbing the spinal nerves. It’s used for childbirth and in surgical settings. 
  • Epidural steroid injections are used to manage chronic back pain. Rather than an anesthetic, this injection involves steroid medication to block the immune response around the irritated spinal nerves. This brings down swelling, giving the nerves a chance to recover.

How Long Will My Back Be Sore After an Epidural?

Your back may be sore for a few days after an epidural. However, this varies depending on the type of injection and the patient’s general condition. 

  • After epidural anesthesia, soreness at the injection site typically improves within one to two days. 
  • After an epidural steroid injection, you may experience a few days of injection site soreness. Additionally, you may still experience back pain until the epidural medication kicks in, which can take up to one week. Some patients’ back pain gets temporarily worse before it gets better after an epidural steroid injection. 

What Causes Back Pain from an Epidural?

Back pain from an epidural typically comes down to temporary soreness at the injection site. If your pain lingers after a few days or weeks, it may be due to:

  • Postpartum pain

Back pain after pregnancy is common and considered to be normal. If you received an epidural during labor and your back pain persists longer than a few days, your pain is more likely a result of factors like:

  • Shifting hormones, which cause the joints to restabilize after childbirth
  • Excessive pressure on your back during pregnancy
  • Changes in your posture after pregnancy
  • Stress and fatigue
  • Stretched abdominal muscles during childbirth, which places more impact on the back 
  • Nerve damage

Though rare, improper needle placement during an epidural injection can lead to chronic back pain, numbness, tingling, and weakness. In these cases, the needle hits the spinal cord, a nerve, or a collection of nerves, leading to irritation and damage. Keep in mind that epidural nerve damage is very rare, with an incidence of less than 1%.  

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What Are the Symptoms of Epidural Nerve Damage?

The symptoms of epidural nerve damage are a loss of sensation or movement in the lower extremities and numbness in a small area of the back. 

Epidural nerve damage symptoms can be temporary or permanent, depending on the extent of the damage. Temporary nerve damage typically subsides within a few days, weeks, or months. 

Permanent epidural nerve damage is very rare, but can cause a permanent loss of sensation or movement in the lower extremities. Along with an improperly placed needle, this can result from the following factors after an epidural:

  • Pressure on the spinal cord caused by bleeding in the epidural region
  • An infection close to the spinal cord or in the epidural region

Rest assured, anesthesiologists are carefully and thoroughly trained to prevent these complications and avoid nerve damage during epidurals. 

How Do You Get Rid of Back Pain From an Epidural?

To get rid of back pain from an epidural, rest, use heat/cold therapy, take over-the-counter pain medication, and attend all recommended physical therapy appointments. Alternative therapies like massage and electrostimulation may also help. 

  • Resting for a few days can help alleviate post-epidural back soreness. Try resting in positions that minimize pressure on the sore part of the spine, like lying down. Additionally, take a break from strenuous physical activity and try low-impact alternatives, like walking, swimming, and water aerobics. 
  • Heat and cold therapy can help bring down swelling, calm tense muscles, and boost blood flow to your back after an epidural. This can alleviate soreness and make you feel more comfortable after an epidural. 
  • OTC pain medication can provide temporary relief after an epidural. While this is usually safe, talk to your doctor before taking any medication or supplement after an epidural to prevent harmful interactions. Also, keep in mind that painkillers are generally only recommended for short-term use and shouldn’t be considered a permanent fix for back pain. 
  • Physical therapy may be suggested after an epidural steroid injection to promote mobility and strength. A physical therapist can recommend a personalized exercise routine to reduce back pain and improve muscular support for your spine. 
  • Alternative therapies including massage and electrostimulation can help with lingering soreness and pain after an epidural.
    • Massage therapy involves manually manipulating soft tissues to reduce tension, encourage relaxation, and improve circulation. It’s a great way to address back soreness after an epidural without medication. 
    • Electrostimulation involves delivering electrical impulses to the muscles and nerves. It stimulates muscle contractions in a process that reduces pain, calms muscle spasms, and improves mobility. 

If you continue to experience back pain a few weeks after an epidural (even after resting, icing, and attending all recommended appointments), contact your physician for further advice. 

Can an Epidural Cause Permanent Back Pain?

Epidurals don’t cause permanent back pain, except in very rare cases. 

Thankfully, back pain after an epidural is almost always temporary and goes away within a few days or weeks. Permanent back pain after an epidural is extremely rare and generally results from a mistake during the procedure, like incorrect needle placement. Your doctor can explain your risk of complications before the procedure and suggest possible alternatives, if applicable.