Injections Didn't Help Your Pain?

Published March 3, 2026 · 7 min read

By Tauri Urbanik, research writer and PainApp founder

You were told the injection would help

The doctor pointed at your MRI. There's the disc. There's the nerve. We'll inject right here, reduce the inflammation, and the pain should calm down.

It made perfect sense. You got the injection. You waited. Maybe it helped for a week. Maybe two. Maybe it didn't help at all. And now you're wondering what went wrong.

Nothing went wrong with the injection. It did exactly what it was designed to do. The problem is that your pain might not be coming from where the needle went. This is a pattern seen across many treatments that fail for chronic pain.

What injections actually do

Cortisone shots and epidural injections target a specific location in your body. They reduce inflammation or numb nerve signals at that exact spot. When there's genuine tissue inflammation pressing on a nerve, this can provide real relief.

But here's the question nobody asks: what if there's no significant inflammation driving your pain?

Research on people with zero pain found that disc bulges, herniations, and degeneration are incredibly common in pain-free individuals (Brinjikji et al., AJNR, 2015↗). By age 40, half of people without any pain have disc bulges on MRI. The finding that led to your injection may not have been the cause of your pain.

The injection told you something important

If an injection targets a specific structure and the pain doesn't change, or comes back quickly, that structure probably wasn't the problem. Your doctor targeted where the MRI pointed. The MRI pointed at something that might be completely irrelevant to your pain.

This isn't a criticism of your doctor. They followed the standard protocol. The issue is that the standard protocol was built on an assumption that pain equals structural damage. Pain neuroscience has moved beyond that assumption.

Brain imaging studies show that chronic pain often shifts from tissue-based signals to learned brain patterns (Hashmi et al., Brain, 2013↗). Once that shift happens, no injection can reach the real source. Because the source is in your neural pathways, not your spine.

Epidural injections and nerve blocks

Epidural steroid injections and nerve blocks work the same way in principle: deliver medication to a specific nerve or space to interrupt the pain signal. When a nerve is genuinely compressed and inflamed, that can help for a while.

But if the relief is brief, partial, or absent, that's telling you something. A nerve block that doesn't hold means it isn't reaching the real driver. The pain pathway switches back on the moment the anesthetic fades, because the pattern generating it lives in the brain, not the nerve you numbed. The same logic applies to a caudal epidural, a transforaminal injection, or a diagnostic nerve block. Temporary relief followed by a full return of pain is a hallmark of neuroplastic pain, not structural nerve damage.

What actually works when injections fail

If your pain is coming from learned brain pathways rather than tissue damage, the treatment needs to target the brain. This is what neuroplastic pain research has shown.

In a clinical trial published in JAMA Psychiatry, Pain Reprocessing Therapy was tested in the PRT trial; 33 of 50 participants with primary chronic back pain were pain-free or nearly pain-free in just 4 weeks (Ashar et al., JAMA Psychiatry, 2022↗). No needles. No medication. Just retraining the brain's pain response.

M

Mark, 52

back pain for 9 years

Mark had five epidural injections over three years. The first one helped for about two weeks. The second helped less. By the fifth, he felt nothing. His doctor suggested trying a nerve block next. That's when Mark started reading about neuroplastic pain. He noticed his pain was always worse on Mondays and better on vacation. It didn't match a structural pattern. It matched a brain pattern. Within a month of brain retraining, the pain he'd been injecting for years started to lift.

Composite story based on common patient patterns. Not a specific individual.

The failed injection isn't a dead end

Here's the reframe. Your injection didn't fail. It succeeded at telling you something valuable: the pain isn't coming from where everyone thought. That information points you toward the actual source. And the actual source has treatments that work. If you've also tried surgery without relief, that's even more evidence pointing in the same direction.

Frequently asked questions

Why didn't my cortisone shot help my pain?

Cortisone reduces inflammation at a specific spot. But if your chronic pain is neuroplastic (brain-generated), there's no inflammation to reduce. The injection targeted the wrong thing. The pain signal is coming from learned brain pathways, not damaged tissue.

Why did my epidural injection only help temporarily?

Epidurals numb a specific nerve area. If pain returns after the numbing wears off, the nerve wasn't the primary driver. Research shows epidural outcomes for chronic pain are often no better than no injection at all. The brain's pain pathways reactivate once the block fades.

Does injection failure mean my pain is in my head?

No. Neuroplastic pain is generated by real neural pathways. It activates the same brain regions as a broken bone. The pain is 100% real. The source is different from what injections target. And it responds to brain-based treatment.

What should I try after injections didn't work?

Consider that your pain may be neuroplastic. Brain-based approaches like Pain Reprocessing Therapy have achieved the 33-of-50 pain-free-or-nearly-pain-free result in the PRT group in clinical trials. A quick assessment can help you check if your pain patterns match the neuroplastic profile.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.DOI: 10.1001/jamapsychiatry.2021.2669
2. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.DOI: 10.3174/ajnr.A4173
3. Hashmi JA, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.DOI: 10.1093/brain/awt211