Back Pain After an Epidural
Epidurals are prominent pain relief treatments for childbirth, surgery, and back pain; they involve injecting medication into the space around the spinal nerves in the lower back. Unfortunately, back pain is a prevalent epidural side effect: in a Medicina study, 30.38% of postpartum women who received epidural analgesia reported back pain in the days after delivery, and 31.65% of the epidural group still had back pain six months post-delivery.
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, widely used during labor, and epidural steroid injections, used for some chronic pain patients.
- 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.
Is it Normal to Have Back Pain After an Epidural?
Yes, it’s normal to have some pain and tenderness around the injection site after an epidural. Usually, this pain goes away within a few days.
How Long Will My Back Be Sore After an Epidural?
Your back may be sore for a few days after an epidural. Post-epidural back pain can vary based on the type of injection:
- 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 natural effects of pregnancy, stress, fatigue, fluid pressure, muscle tension, or nerve damage.
For postpartum patients, post-epidural back pain can be caused by:
- 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
For chronic pain patients, back pain after an epidural steroid injection can result from:
- Fluid pressure: the injection increases the volume of fluid in the epidural space, temporarily increasing pressure on the spinal nerves.
- Muscle tension: the injection can cause your lower back muscles to tighten as a protective reflex.
- 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%.
Other Epidural Side Effects to Know
Common epidural side effects include:
- Soreness and tenderness at the injection site
- Itchy skin
- Low blood pressure
- Fatigue
- Heaviness in the legs
- Nausea
Talk to your doctor if any of these side effects are severe or persistent.
While rare, more severe side effects are also possible with an epidural. Seek immediate medical care if you experience:
- Severe headache
- Infection symptoms (fever, chills, warmth, redness, or pus at injection site)
- Changes in bowel or bladder control
- Neurological symptoms (weakness, numbness, or tingling in the lower body)
- Spinal epidural hematoma (SEH), pooled blood in the fluid or space around the spinal cord
Spinal Headache After an Epidural
A spinal headache is a severe headache that results from leaking cerebrospinal fluid (CSF), which lowers the pressure around your spinal cord and brain. According to Neurosciences Journal, the most common cause of a headache after an epidural is what’s called unintentional dural puncture, or UDP. This means that the needle inadvertently punctured the dura mater (the membrane that surrounds the spinal cord and brain) during the epidural.
- Prevalence: The American Society of Anesthesiologists reported that unintentional dural puncture is the most common complication of labor epidural catheter placement, occurring in 0.51 to 1.5% of obstetric patients, and post-dural puncture headache may develop in 50 to 80% of patients.
- Symptoms:
- Intense headache starting in the front or back of the head
- Headache pain that intensifies when you sit, stand, cough, or sneeze
- Headache pain that improves with lying down
- Neck stiffness or pain
- Nausea or dizziness
- Light sensitivity or ringing in ears (tinnitus)
- How it’s treated: In most cases, spinal headaches go away on their own with at-home care.
- Home care: Try lying flat, taking over-the-counter painkillers, and drinking plenty of fluids, including caffeinated drinks.
- Professional care: If these methods don’t work, your provider may suggest an epidural blood patch, which involves injecting a small amount of your blood over the puncture hole to close it with a clot.
Normal Post-Epidural Soreness vs. Warning Signs
Refer to the table below to help differentiate between normal signs of recovery and potential warning signs after an epidural.
| Table: Normal Post-Epidural Soreness vs. Warning Signs | |
| Normal Recovery Symptoms | Red Flag Symptoms (Seek Emergency Care) |
| Mild injection site soreness & tenderness; itchy skin; fatigue; temporary pain increase (for chronic pain epidural injection) | Fever, redness, or chills at injection site; severe, persistent headache; severe pain that doesn’t improve; new or worsening weakness or numbness in extremities; changes in bowel or bladder function |
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.
When Can I Exercise and Return to Normal Activity?
After an epidural steroid injection, you can typically return to gentle walking and light tasks the next day. Wait a week until returning to exercise, or until you’re cleared by your doctor. Avoid high-impact workouts for at least 2 weeks, or as advised.
When in doubt, talk to your doctor before returning to activities after an epidural.
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.
In a study of 460 postpartum women published in the Indian Journal of Anaesthesia, the prevalence of postpartum back pain was nearly identical between the epidural analgesia group and the non-epidural group. Interestingly, at the one- and three-month follow-ups, back pain was less common in the epidural group.
Back Pain for Months or Years After an Epidural
If you experience back pain months or years after an epidural, you may assume that it stems from the epidural. But, for people who had an epidural during childbirth, the pain is more likely to stem from the physical demands of pregnancy and labor (weakened core muscles, changes in posture, and natural age-related wear and tear).
This is corroborated by the Indian Journal of Anaesthesia study mentioned above, as well as a Medicina study that found that labor pain relief techniques (epidural analgesia vs. intravenous drugs vs. no anesthesia) didn’t increase the risk of back pain in the early postpartum period and six months after childbirth.
Frequently Asked Questions
Is back pain after an epidural anesthesia normal?
Mild, temporary back pain is normal after an epidural. If you experience severe, worsening, or persistent back pain, or back pain with red flag symptoms (like neurological symptoms or signs of infection), contact your doctor or seek emergency medical care.
How long does back pain last after an epidural steroid injection?
Normal back pain after an epidural steroid injection lasts a few days. The injection should start working within two to seven days and provide relief for a few months (or longer).
Can an epidural cause a spinal headache?
Yes, an epidural can cause a spinal headache, most often from unintentional dural puncture. It often feels like an intense headache that worsens when you sit or stand.
Can an epidural cause back pain years later?
Epidurals very rarely cause back pain years later (this usually only occurs in cases of nerve damage, which is highly uncommon). If you experience back pain years down the line, it’s more likely due to other factors, like the physical trauma of childbirth.
When should I worry about back pain after an epidural?
Seek professional care for back pain after an epidural if it’s severe, worsening, or occurs with other concerning symptoms like fever, leg weakness or numbness, or changes in bowel or bladder function.
Wrap-Up: Finding the Right Treatment for You
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If you’re struggling with chronic back pain from a condition like spinal stenosis or spondylolisthesis, epidural steroid injections aren’t your only treatment option. Modern innovations, like the TOPS System, may provide superior, long-lasting relief. Contact a spine specialist in your area to learn more.