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Office Based Procedures

Transforaminal / Epidural Steroid Injection (TFE)/(ESI)

This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. The injection takes only a few minutes to complete.

What is a Transforaminal / Epidural Steroid Injection (TFE/ESI)?

This is an outpatient procedure in which we inject steroid medication into the epidural space. Sometimes, a local anesthetic is added to the steroid mixture. The epidural space is a space located in the spine between the vertebrae. The goal of a TFE/ESI is to provide relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. A TFE/ESI will not correct the pre-existing medical problem (i.e. spinal stenosis, herniated or bulging disc, arthritis, etc.) but may decrease the level of pain. The injections are done in a series of three, approximately 1 month apart. An injection may be repeated every 3 months if the pain returns.

How long does the TFE/ESI procedure take?

The procedure takes about 10 minutes.

What are the pre-requisites in order to perform this procedure?

You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the injection hurt?

Most people report that the stinging or burning of the numbing medicine is the most uncomfortable part of the procedure though every person’s response to any procedure is individual.

What should I expect after the procedure and what are the side effects?

Most people don’t feel any different immediately after the injection though the pain may be temporarily removed or worsened. The steroid medication takes two or three days to start to have an effect in most people and peaks in about one week. Therefore, it may be awhile before you feel a change in your pain. Some tenderness around the injection site may be experienced for a couple of days after the injection. Using an ice pack with a barrier such as a towel between the ice and skin three or four times a day will help this. You may take your prescribed pain medications after the injection. It is important that you keep track of the amount of pain medication you are using.

What should I do after the procedure?

No heat is to be used on or around the injected area for the remainder of the day. No tub, bath, or soaking in water (i.e. pool, Jacuzzi, etc.) for at least 48 hours. You may eat, drink, and take your medications as prescribed on the day of the procedure (both before and after) unless instructed otherwise by your physician.


Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.

North Shore Pain Management
Our team is dedicated to the care and treatment of patients in pain. New patients are seen on physician referral only. To help us diagnose and treat, we must have relevant medical records, x-rays, and test reports. We accept most major health insurance plans.
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