By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated April 2026
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Back and neck pain that radiates into your arms or legs can make everyday activities feel impossible. When physical therapy and medications have not provided enough relief, an epidural steroid injection may be the next step toward getting your life back.
At Performance Pain and Sports Medicine in Houston, epidural steroid injections are performed using fluoroscopic guidance to deliver anti-inflammatory medication precisely where it is needed. As a board-certified pain medicine specialist, Dr. Manzi evaluates each patient’s imaging and symptoms to determine whether an epidural injection can address the specific source of pain rather than simply managing it short-term.
The Houston office is located in the T-Mobile Tower on the Southwest Freeway, near the Galleria and easily accessible from River Oaks, West University, and the surrounding communities. If chronic spine pain has limited your ability to work, exercise, or enjoy time with your family, exploring whether this treatment may help is encouraged.
What Is an Epidural Steroid Injection?
An epidural steroid injection (ESI) delivers anti-inflammatory medication directly into the epidural space surrounding your spinal nerves. The epidural space is the area between the protective covering of the spinal cord (the dura) and the vertebrae. When a herniated disc, bone spur, or narrowed spinal canal presses on a nerve root, it creates inflammation that causes pain, numbness, or weakness in your back, neck, arms, or legs.
The injection contains two components: a corticosteroid that reduces inflammation at the nerve root and a local anesthetic that provides immediate but temporary pain relief. Together, these medications calm the irritated nerve and create a window for healing and rehabilitation.
All epidural steroid injections at PPSM are performed under fluoroscopic guidance, which means real-time X-ray imaging is used to guide the needle to the precise location. This image-guided approach helps ensure the medication reaches the targeted nerve root accurately. According to the American Society of Interventional Pain Physicians (ASIPP), fluoroscopically guided epidural injections carry Level I evidence supporting their long-term effectiveness for conditions like disc herniation (Manchikanti L et al., Pain Physician, 2021).
There are three primary approaches to epidural steroid injections, and the approach is selected based on each patient’s specific condition and anatomy:
- Interlaminar: The needle enters between two vertebrae from the back. This is the most common approach and covers a broad area of the epidural space.
- Transforaminal: The needle enters from the side, targeting the specific nerve root where it exits the spine. This delivers a more concentrated dose to the affected nerve.
- Caudal: The needle enters through the sacral opening at the base of the spine. This approach is often used for lower back conditions affecting multiple nerve levels.
The most appropriate approach is recommended after reviewing the patient’s imaging and evaluating their symptoms during the consultation.
Conditions Treated with Epidural Steroid Injections
Epidural steroid injections can help manage pain from several spinal conditions that involve nerve root inflammation or compression. A 2022 systematic review in Pain Physician confirmed that epidural injections are effective for lumbar radiculopathy (Manchikanti L et al., 2022), and the American Academy of Neurology (2025) found that ESIs probably reduce short-term pain and disability in both cervical and lumbar radiculopathies (Armon C et al., Neurology, 2025).
Epidural steroid injections are commonly recommended for patients at the Houston practice who are experiencing:
- Herniated or bulging disc: When disc material presses on a spinal nerve, it causes inflammation that radiates pain into the arms or legs. An ESI can reduce that inflammation at the nerve root.
- Sciatica (lumbar radiculopathy): Shooting pain that travels from the lower back down through the buttock and into the leg. This is one of the most common reasons patients seek epidural injections.
- Spinal stenosis: Narrowing of the spinal canal that compresses the nerves. ESIs can help relieve the leg pain and cramping that often accompany this condition.
- Degenerative disc disease: As discs lose height and hydration over time, they can irritate surrounding nerves. Targeted injections may reduce the resulting inflammation.
- Cervical radiculopathy: Nerve compression in the neck that causes pain, tingling, or weakness radiating into the shoulder and arm. Cervical epidural injections address this at the source.
- Failed back surgery syndrome: Some patients continue to experience pain after spinal surgery. Epidural injections can help manage persistent nerve irritation in these cases.
- Spondylolisthesis: When a vertebra slips forward over the one below it, the resulting nerve compression may respond to epidural steroid treatment.
During the consultation, the patient’s MRI or other imaging is reviewed to identify which condition is driving their symptoms and whether an epidural steroid injection is likely to help.
What to Expect During Your Epidural Steroid Injection
Knowing what happens before, during, and after the procedure can help patients feel prepared and confident on the day of the injection. Here is a step-by-step overview of the process at the Houston office.
Before Your Procedure
The epidural steroid injection begins with a thorough evaluation. The physician reviews the patient’s MRI or CT imaging, discusses their pain history, and confirms that an ESI is appropriate for their condition. Patients receive specific instructions about medications to pause before the procedure, particularly blood thinners. Plan to have someone available to drive you home afterward.
During Your Procedure
The injection itself typically takes 15 to 30 minutes and is performed as an outpatient procedure at the Houston office in the T-Mobile Tower or at one of the affiliated surgery centers. The patient lies face down on a procedure table, and the injection area is cleaned and numbed with a local anesthetic. Using fluoroscopic (real-time X-ray) guidance, the needle is carefully advanced into the epidural space at the targeted level of the spine. Once correct needle placement is confirmed on the fluoroscopy monitor, the corticosteroid and anesthetic medication are injected. Most patients describe the sensation as pressure rather than sharp pain.
After Your Procedure
Patients rest in the recovery area for 15 to 30 minutes while the care team monitors them. Some patients notice immediate relief from the local anesthetic, although this is temporary. The corticosteroid typically takes 2 to 7 days to reach its full anti-inflammatory effect, according to the Cleveland Clinic. Patients can generally return to light daily activities the following day, though strenuous exercise and heavy lifting are recommended to be avoided for 24 to 48 hours. A follow-up is scheduled to assess each patient’s response and determine whether additional injections may be beneficial.
Benefits of Epidural Steroid Injections
For patients dealing with chronic back or neck pain from nerve compression, epidural steroid injections offer several meaningful advantages as part of a comprehensive treatment plan.
- Minimally invasive and non-surgical. An ESI requires only a needle insertion, with no incisions, no general anesthesia, and no hospital stay. Patients can return home the same day.
- Targeted inflammation reduction. Unlike oral medications that circulate throughout the entire body, an epidural injection delivers the anti-inflammatory medication directly to the inflamed nerve root where it is needed most.
- May reduce or delay the need for surgery. Research published in The Spine Journal followed patients for five years after lumbar transforaminal epidural steroid injections and found sustained benefit with reduced progression to surgical intervention (Kennedy DJ et al., 2018).
- Enables participation in rehabilitation. One of the most important benefits is that pain relief from an ESI can allow patients to engage more fully in physical therapy and exercise, which are essential for long-term recovery.
- Quick procedure with fast recovery. The injection takes 15 to 30 minutes, and most patients resume light activities the following day. There is no extended downtime or recovery period.
- Can be repeated if effective. If an initial injection provides meaningful relief, the physician may recommend a series of up to three injections to extend the benefit. The ASIPP guidelines support repeated epidural injections when clinical improvement is documented (Manchikanti L et al., Pain Physician, 2021).
It is important to understand that epidural steroid injections work best as one component of a broader pain management strategy. ESIs are typically combined with physical therapy, activity modification, and other conservative treatments tailored to each patient’s specific condition and goals.
If you are considering epidural steroid injections for back or neck pain, call the Houston office at 346-217-1111 to schedule a consultation and discuss whether ESI is right for you.
Why Choose Performance Pain and Sports Medicine in Houston for Epidural Steroid Injections
When patients choose epidural steroid injections at the Houston practice, they benefit from a physician-led care team with advanced training in interventional spine procedures and pain management.
Dr. Suzanne Manzi, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine — brings fellowship training in interventional spine and pain management from Michigan State University to every patient evaluation. Her role as teaching faculty at UT Health Houston McGovern Medical School keeps her connected to the latest evidence and clinical practices in interventional pain medicine, which directly benefits Houston patients through treatment approaches informed by current research.
Dr. Matthias Wiederholz, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Sports Medicine, Pain Medicine, and Anti-Aging, Regenerative & Functional Medicine — brings additional expertise in sports medicine and regenerative approaches to the pain management team. His training across multiple disciplines allows the practice to evaluate spine pain from both an interventional and functional rehabilitation perspective.
Jade Nemeth, PA-C, supports patients through every stage of the treatment process, from initial evaluation through post-procedure follow-up care.
What sets the Houston practice apart:
- Physician-led care with board-certified specialists trained in interventional pain management
- All epidural steroid injections performed under fluoroscopic guidance for precision
- Dedicated one-on-one consultation time
- Comprehensive evaluation before recommending any procedure
- Convenient Houston office location in the T-Mobile Tower near the Galleria, accessible from River Oaks, West University, and the greater Houston area
At PPSM, the right approach to chronic pain starts with a thorough evaluation and an honest conversation about options. When an epidural steroid injection is appropriate, the team guides patients through every step of the process.
Our Houston Location
Performance Pain and Sports Medicine occupies Suite 1700 of the T-Mobile Tower, providing convenient access from virtually anywhere in the Greater Houston area. The building sits near one of Houston’s most recognizable intersections, where the Southwest Freeway (I-59) meets the West Loop (610).
Performance Pain and Sports Medicine — Houston:
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, 17th Floor
Phone: 346-217-1111
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Nearby Neighborhoods: River Oaks, Galleria, Bellaire, West University, Montrose
Whether you are coming from the Heights, Clear Lake, or Sugar Land, the central location keeps your commute manageable. Visit the Houston location page for directions and office hours.
Frequently Asked Questions: Epidural Steroid Injections in Houston
How much does an epidural steroid injection cost in Texas?
The cost of an epidural steroid injection in Texas varies depending on the type of injection, the facility where it is performed, and your insurance coverage. With insurance, most patients pay a copay or coinsurance amount. Without insurance, costs can range widely. Contacting the Houston office at 346-217-1111 to discuss pricing and payment options for your specific situation is recommended.
Does insurance cover epidural steroid injections?
Many insurance plans cover epidural steroid injections when they are deemed medically necessary. Coverage depends on your specific plan, diagnosis, and whether prior authorization is required. The team at PPSM can help verify your benefits before your procedure. Contact us to confirm your coverage.
Will an epidural steroid injection help a herniated disc?
Herniated discs are one of the most common conditions treated with epidural steroid injections. Research supports the use of ESIs for reducing pain and inflammation caused by disc herniation, particularly when the disc is compressing a spinal nerve. However, not every herniated disc requires an injection. The physician will review each patient’s imaging and symptoms to determine whether an ESI is appropriate for their case.
How long does pain relief last after an epidural steroid injection?
The duration of relief varies from patient to patient. Some patients experience weeks of relief, while others may benefit for several months or longer. A 2025 systematic review published in Neurology found that epidural steroid injections probably reduce short-term pain in cervical and lumbar radiculopathies (Armon C et al., 2025). Factors such as the underlying condition, severity of inflammation, and whether the patient participates in follow-up rehabilitation all influence how long relief lasts.
How many epidural steroid injections can I receive?
There is no single universal limit, but most physicians follow general guidelines of no more than three to four epidural steroid injections within a six-month period. The decision depends on each patient’s response to the injection and whether the clinical benefit justifies additional treatments. The treating physician reassesses after each injection and only recommends repeating the procedure when there is documented improvement.
How soon can I return to normal activities after an epidural steroid injection?
Most patients return to light daily activities the day after their injection. Strenuous exercise, heavy lifting, and prolonged bending are recommended to be avoided for 24 to 48 hours. The injection site may feel sore for a day or two, which is normal. The treating physician will provide specific activity guidelines based on the type of injection received and the patient’s overall condition.
Schedule Your Epidural Steroid Injection Consultation in Houston
If chronic back pain, neck pain, or radiating nerve pain has limited your ability to stay active, finding out whether an epidural steroid injection can help is encouraged. At Performance Pain and Sports Medicine, the team takes the time to evaluate each condition thoroughly and recommends treatment only when the evidence supports it.
Contact the Houston office to schedule a consultation with Dr. Manzi, or call 346-217-1111.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Performance Pain and Sports Medicine — Suzanne Manzi, MD
Medically reviewed by Suzanne Manzi, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. Teaching Faculty, UT Health Houston McGovern Medical School. Last reviewed April 2026.
