How Many Epidural Steroid Injections Can You Have Per Year?

At Pain Treatment Center of Maryland in Reisterstown, MD, patients who have been receiving epidural steroid injections often ask us: how many can I actually have, and what happens when they stop working? It is one of the most common follow-up questions we hear, and it deserves a thorough, honest answer.

The General Guideline: 3 Injections Per Year Per Spinal Region

Most pain management physicians — including the guidelines published by the American Society of Interventional Pain Physicians — recommend a maximum of 3 epidural steroid injections per spinal region per year. This means you could potentially receive up to 3 cervical (neck) epidurals and 3 lumbar (lower back) epidurals in the same year, since they target different spinal regions.

The reason for this limit is the cumulative effect of corticosteroids on the body. While a single epidural injection is considered very safe, repeated steroid exposure over a short period can lead to:

• Suppression of the adrenal glands (the body's natural cortisol production)
• Potential weakening of bone density (osteoporosis risk)
• Elevated blood sugar levels (particularly concerning for diabetic patients)
• Soft tissue changes at the injection site

These effects are dose-dependent and cumulative, which is why spacing injections appropriately and limiting the total number per year is essential for patient safety.

Why More Is Not Always Better

Some patients experience excellent relief from their first epidural and understandably want to continue receiving them indefinitely. However, if an epidural provides diminishing returns — meaning each injection provides less relief or shorter duration — it is a clinical signal that the underlying condition may require a different treatment approach.

Dr. Reznikov carefully tracks each patient's response to epidural injections. If you are not achieving meaningful relief after 2-3 injections in a series, continuing the same approach is unlikely to produce better results and may expose you to unnecessary steroid accumulation.

What Happens When Epidural Injections Stop Working?

When epidurals reach their limit — either because you have received the maximum number for the year or because they are no longer providing adequate relief — several pathways are available:

The Diagnostic-to-Therapeutic Pathway: ESI → Medial Branch Block → RFA

One of the most effective next steps is the diagnostic-to-therapeutic pathway. This approach uses a medial branch block to determine whether facet joints are contributing to your pain. If the diagnostic block confirms facet joint involvement, radiofrequency ablation (RFA) can provide pain relief lasting 6-18 months by disrupting the nerve signals carrying pain from the facet joint.

This pathway is particularly effective for patients with:

• Chronic lower back pain with a facet joint component
• Degenerative disc disease with facet arthropathy
• Neck pain that has not fully responded to cervical epidurals

When Is RFA the Right Next Step?

Radiofrequency ablation is typically recommended when:

• Epidural steroid injections provided only partial or temporary relief
• A diagnostic medial branch block confirmed facet joint pain (at least 80% pain reduction)
• Pain is primarily axial (in the spine) rather than radiating into the arms or legs
• Conservative treatments (physical therapy, medications) have been insufficient

RFA uses radiofrequency energy to create a heat lesion on the medial branch nerve, interrupting its ability to transmit pain signals. The nerve eventually regenerates, but relief typically lasts 6-18 months, and the procedure can be repeated.

Other Options When ESI Frequency Limits Are Reached

Beyond the medial branch block and RFA pathway, other treatment options include:

• Nerve blocks: Targeted peripheral nerve blocks can address specific pain generators that epidurals may not reach
• Trigger point injections: For patients with myofascial pain contributing to their symptoms
• Core strengthening: Emsculpt Neo can strengthen the core and paraspinal muscles that support spinal stability
• Medication management: Adjusting pain medications during the interval between injection cycles
• Physical therapy: Structured rehabilitation to maintain function and reduce reliance on injections

Frequently Asked Questions

How often can you get an epidural steroid injection?

The standard guideline is a maximum of 3 epidural steroid injections per spinal region per year, typically spaced at least 2-4 weeks apart. This limit protects against cumulative steroid side effects.

Can I get epidural injections in different parts of my spine in the same year?

Yes. The 3-per-year limit applies per spinal region. You could receive cervical, thoracic, and lumbar epidurals in the same year, as each targets a different anatomical area.

What if my epidural only lasted a few weeks?

Short-duration relief may indicate that the pain generator is not primarily inflammatory, or that the epidural did not reach the exact source. Dr. Reznikov may recommend a different injection approach, a diagnostic medial branch block, or advanced imaging to reassess the underlying condition.

Is radiofrequency ablation safe after epidural injections?

Yes. RFA is a well-established procedure with a strong safety profile. It targets a different mechanism than epidurals — nerve signal disruption rather than inflammation reduction — making it an appropriate next step when epidurals are no longer sufficient.

How long does radiofrequency ablation pain relief last?

Most patients experience relief lasting 6-18 months. When the treated nerve regenerates and pain returns, the procedure can be safely repeated.

Do I need a medial branch block before RFA?

Yes. A diagnostic medial branch block is required before radiofrequency ablation to confirm that the facet joints are the source of pain. Most insurance companies require at least one (often two) successful diagnostic blocks before authorizing RFA.

Will my insurance cover radiofrequency ablation?

RFA is covered by most major insurance plans when preceded by positive diagnostic medial branch blocks. Our office staff can assist with insurance verification and prior authorization.

Can I receive epidural injections again next year?

Yes. The annual limit resets, and many patients benefit from a yearly series of epidural injections as part of a comprehensive pain management plan. Dr. Reznikov will reassess your condition and adjust your treatment plan at each visit.

Review Your Treatment Plan

If you have been receiving epidural steroid injections and are wondering about your options, book a consultation with Dr. Reznikov at Pain Treatment Center of Maryland in Reisterstown, MD. We will review your injection history, assess your current condition, and develop a plan for sustained pain relief. Call (410) 833-1011 today.