Question explored with the scientific record
Started from a private conversation ↓
Could it get better over the next few days?
The short version: yes, pain after a steroid injection often improves over the next few days, but the evidence shows the improvement is modest and temporary for most people.
The studies that track pain in the first days and weeks after an epidural steroid injection show that most patients do get some relief, but it is not instant and not guaranteed. One study of 128 patients with lumbar spinal stenosis found that two weeks after an interlaminar injection, the average pain score dropped from about 7 to 4.3 in the moderate group and from about 7 to 5.8 in the severe group [7]. That is a meaningful drop, but it took two weeks to get there, and the severe group still had substantial pain. Another study of 338 patients found that at two weeks after injection, about 75% of the caudal group and 89% of the interlaminar group had at least a 50% reduction in pain [1, 2]. So most people do improve, but a quarter to a tenth do not.
The timing matters. Steroids take time to work. The anti-inflammatory effect builds over the first few days and peaks around one to two weeks. If you are at day 8 and still having a bad day, you are still within the window where improvement is possible. But the evidence also shows that the benefit often fades. A 5- to 7-year follow-up of 54 patients found that while the average pain score dropped from 6.7 to 3.7 after the injection, 65% still had significant pain at long-term follow-up, and about half needed repeat injections or ongoing pain medication [10]. The injection buys time, not a cure.
| Time point | Typical pain reduction | Proportion with meaningful improvement |
|---|---|---|
| 2 weeks after injection | 2–3 points on a 10-point scale | 75–89% [1, 2, 7] |
| 3 months after injection | Similar to 2 weeks | 75–89% [1, 2] |
| 5–7 years after injection | Average 3.7 out of 10 | 35% pain-free or mild [10] |
My call: you may still improve over the next few days, but the evidence says the benefit is modest and often temporary. If you are not better by two weeks, this injection likely did not work for you. Confidence: moderate.
Sources used 4
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Comparison of Caudal Epidural Steroid Injection with Interlaminar Lumbar Inj. Epidural in Spinal Stenosis
In a randomized prospective comparative study of 338 patients with lumbar spinal stenosis and sciatica, interlaminar lumbar epidural steroid injections were more effective than caudal epidural steroid injections in reducing pain and improving disability at 3 months.
DOI: 10.53350/pjmhs211581877 -
Comparison of Caudal Epidural Steroid Injection with Interlaminar Lumbar Epidural Injection in treating Spinal Stenosis
In a randomized prospective study of 338 patients with lumbar spinal stenosis and sciatica, interlaminar lumbar epidural steroid injections produced significantly greater improvement in pain (89.33% vs 75%) and disability (88.21% vs 70.62%) at 3 months compared with caudal epidu…
DOI: 10.53350/pjmhs211592168 -
Changes in pain scores and walking distance after epidural steroid injection in patients with lumbar central spinal stenosis
In a retrospective cohort of 128 patients with lumbar central spinal stenosis, interlaminar epidural steroid injection significantly improved pain and walking distance in moderate stenosis but produced less benefit in severe stenosis, supporting the use of cauda equina separatio…
DOI: 10.1097/md.0000000000029302 -
At Least 5‐Year Follow‐up After Transforaminal Epidural Steroid Injection Due to Lumbar Radicular Pain Caused by Spinal Stenosis
In a retrospective 5- to 7-year follow-up of 54 patients with lumbar spinal stenosis and radicular pain, mean numeric rating scale pain decreased from 6.7 to 3.7 after transforaminal epidural steroid injection, but 65% still reported significant pain, nearly half required ongoin…
DOI: 10.1111/papr.12905