Concierge pain medicine · London
Private epidural steroid injection in London, image-guided, by a consultant.
Image-guided placement by a consultant — with the physio plan alongside the injection, because the drug alone is not the fix.
Why patients choose us
- 01
Image-guided, every time
Every ESI in our network is placed under fluoroscopy or CT — not by landmarking. That is what confirms the needle is where the drug needs to go.
- 02
Rehab comes with the drug
The injection buys a window. What you do in that window decides whether the pain comes back. A physio plan is arranged alongside.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private epidural steroid injection costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A lumbar transforaminal ESI in our network: £900-£1,800, with the steroid effect starting in 3-7 days.
| ESI type | Indicative range | Typical duration | Time to effect |
|---|---|---|---|
| Lumbar transforaminal ESI | £900–£1,800 | 45 min | Same visit |
| Lumbar caudal ESI | £700–£1,400 | 30 min | Same visit |
| Cervical transforaminal ESI | £1,200–£2,400 | 45 min | Same visit |
| Thoracic ESI | £900–£1,800 | 45 min | Same visit |
| ESI + pain consult | £1,200–£2,400 | Half-day | Same visit |
| Post-op ESI (post-fusion) | £900–£1,800 | 45 min | Same visit |
Prices vary by clinic, by who places the injection, by whether fluoroscopy or CT guidance is used, and by whether a pain consultation is bundled in. We come back with a firm quote within one working day.
The problem
An ESI without image guidance is a guess. With it, it isn’t.
The epidural space is millimetres from the nerve root and the dura. Fluoroscopy or CT guidance, with contrast confirmation, is what separates a targeted injection from a hopeful one.
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Frightened of the needle?
The skin is numbed first. Most people describe pressure and a brief zap rather than sharp pain.
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Worried a steroid will harm?
Capped at three to four injections a year, epidural steroid is well tolerated — we plan the frequency carefully.
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Sceptical of a quick fix?
You are right to be. The injection buys a pain-free window. Rehab in that window is what changes the trajectory.
The journey
From enquiry to rehab plan - what happens, in order.
One clinician from first message to review - including the physio plan in between.
Phase 1 · Before your injection
Concierge, off-stage for you
Phase 2 · On the day
~1 hour at the clinic
Phase 3 · After
Rehab + review
- 01
Before
You tell us where it hurts
A short, confidential form. Symptoms, radiation into arm or leg, any prior MRI, and medication — especially blood thinners.
- 02
Before
We come back with a recommendation
Within one working day: which ESI, which specialist, indicative price. If an injection is not the right step, we say so.
- 03
Before
We arrange the appointment
Usually within a week. We review anticoagulation and diabetes control with the team and tell you exactly how to prepare.
- 04
On the day
Arrival at the clinic
Arrival and consent. The area is cleaned and numbed — the only sharp moment is the first small injection of local anaesthetic.
- 05
On the day
The injection itself
30-45 minutes. You are awake and comfortable, with the needle guided by fluoroscopy or CT in real time, and contrast used to confirm position.
- 06
On the day
Home the same day
A short observation and home within the hour. You cannot drive for 24 hours after an ESI — arrange a lift.
- 07
After
Rehab, and review
Steroid effect starts within 3-7 days. A physio plan begins in the same window, and we review at 4-6 weeks to check the response.
Typical end-to-end: 1-2 weeks to injection, then 4-6 weeks of rehab before review.
When it helps
When an epidural steroid injection is the right next step.
Not every back or neck pain needs an ESI. These are the situations where a well-placed one, alongside rehab, tends to earn its keep.
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Sciatica
Nerve-root pain radiating down the leg from a lumbar disc or foraminal narrowing.
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Cervical radiculopathy
Neck pain with radiation into the arm from a cervical nerve root.
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Lumbar disc prolapse
MRI-confirmed disc prolapse pressing on a specific nerve root.
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Foraminal stenosis
Narrowing of the exit foramen where a nerve root leaves the spine.
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Lumbar radiculopathy
Leg pain in a dermatomal pattern where a targeted injection can settle the flare.
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Cervical arm pain
Referred arm pain with weakness or paraesthesia mapping to a single root.
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Thoracic radicular pain
Band-like chest wall pain from a thoracic nerve root, once cardiac causes are excluded.
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Red flag: cauda equina symptoms
Saddle numbness, bladder or bowel change, or bilateral leg weakness — 999, not ESI.
ESI types
Not all epidural injections are the same.
What each option on your referral is actually for.
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Lumbar transforaminal
Targeted injection at a specific lumbar nerve root through the exit foramen — the workhorse for sciatica.
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Lumbar caudal
Injection through the sacral hiatus into the caudal epidural space — useful for multi-level or post-surgical anatomy.
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Cervical transforaminal
Nerve-root injection in the neck for cervical radiculopathy — placed under fluoroscopy or CT for accuracy.
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Thoracic ESI
Epidural steroid at a thoracic level for band-like radicular pain, once other causes are excluded.
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ESI + pain consult
A same-day consultation with the pain-medicine specialist followed by the injection, with a written plan.
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Post-op ESI
Careful injection in the post-fusion or post-decompression spine, by a consultant familiar with altered anatomy.
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Repeat ESI (up to 3-4/year)
Where a first injection helped but symptoms return — most protocols cap at three to four per year.
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ESI + radiofrequency ablation referral
Where facet-mediated pain is co-existing, onward referral for RFA is arranged alongside the ESI plan.
Our vetted London network
A small panel of specialists, we picked them.
Consultant pain-medicine specialists and interventional radiologists across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every specialist in our network.
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FRCA-registered pain-medicine specialists or interventional radiologists
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Fluoroscopy or CT guidance standard, with contrast confirmation of needle position
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Sedation available for anxious patients, arranged in advance
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Onward physio and multidisciplinary pain pathway built in from day one
Safety and eligibility
Safer than most people think, with things worth planning.
Image-guided ESIs are safe in experienced hands. The things worth planning are anticoagulation, diabetes control, driving, and how many injections you have had in the past year.
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Small risk of nerve damage, infection, dural puncture
All ESIs carry a small risk of nerve injury, infection or dural puncture (headache). Image guidance and sterile technique keep these low.
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Driving restriction 24 hours
You cannot drive for 24 hours after an ESI. Arrange a lift home and for the following morning if needed.
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Anticoagulation needs planning
Warfarin, DOACs and clopidogrel need a plan around the injection. Never stop them on your own — we coordinate it with the specialist.
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Diabetes — blood glucose can rise
Steroid can raise blood glucose for several days. Monitor more closely for the first week and tell your diabetes team.
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Limit to 3-4 injections per year
Most protocols cap epidural steroid at three to four injections per year to keep systemic exposure sensible.
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Not a cure — a bridge to rehab
ESI quiets the pain so you can rehab. What you do in that window is what changes the trajectory.
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Pregnancy defers ESI usually
Fluoroscopic and CT-guided injections use ionising radiation. Pregnancy usually means deferring the ESI until after delivery.
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Post-op cases benefit from senior consultant
After fusion or decompression the anatomy is altered — post-op ESIs should be done by a senior consultant familiar with that terrain.
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Always share prior MRI
Bring or send your most recent spine MRI. Targeting depends on knowing which level and which side is generating the pain.
Reading your report
An ESI report is short. Read the last part first.
Whichever level was injected, the report keeps to the same four parts.
A quiet reminder
The injection is only the start — the rehab plan is what makes it stick.
If you would like us to talk you through it before your physio starts, just ask.
- 01 Header
Indication and prior imaging
The clinical question and the imaging it is based on — for example "right L5 radiculopathy, MRI confirms foraminal disc prolapse".
- 02 Technique
Approach, drug and dose
Which level was injected, transforaminal or caudal, the drug used (usually a long-acting steroid with local anaesthetic), and the dose.
- 03 Findings
Fluoroscopy or CT confirmation
A brief note that needle position was confirmed with contrast under live imaging — the safety checkpoint of the procedure.
- 04 Impression
Response expected, rehab and review
Read this first. Expected response, the rehab plan agreed on the day, and the review timing — typically 4-6 weeks.
Recognised by major UK insurers
Most policies cover epidural steroid injections when clinically indicated; we confirm cover and pre-authorisation before booking.
Frequently asked
Everything we get asked about ESIs.
Quick answers on pain, cost, driving, blood thinners, diabetes and how many injections is safe.
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What is an epidural steroid injection?
An ESI is an image-guided injection of a long-acting steroid, usually with local anaesthetic, into the epidural space around an inflamed nerve root in the spine. It is used most often for sciatica or cervical radiculopathy where a specific nerve root has been identified on MRI.
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Is an ESI painful?
Less than most people expect. The skin is numbed with local anaesthetic first, so the sensation is pressure and pushing rather than sharp pain. A brief zap down the leg or arm is possible as the needle approaches the nerve root — the specialist will warn you.
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Can I drive home after an ESI?
No. You cannot drive for 24 hours after an epidural steroid injection. Arrange a lift home on the day, and for the following morning if you can.
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I take blood thinners — what should I do?
Tell us what you take. Warfarin, DOACs and clopidogrel all need a plan around the injection. Never stop them on your own; we coordinate the timing with the specialist and, where needed, with your cardiologist or haematologist.
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I have diabetes — can I still have an ESI?
Yes, but be aware that blood glucose can rise for several days afterwards. Monitor more closely for the first week and let your diabetes team know if control drifts.
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How much does a private ESI cost in London?
A lumbar caudal ESI is typically £700-£1,400 and a lumbar transforaminal £900-£1,800. Cervical transforaminal injections are £1,200-£2,400. An ESI combined with a pain-medicine consultation is £1,200-£2,400. We confirm a firm figure within one working day.
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Do I need a GP referral?
No. Most of our network accepts self-referrals for ESI. Send any prior spine MRI with your enquiry; it almost always speeds the decision.
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How many ESIs can I have?
Most protocols cap epidural steroid at three to four injections in a twelve-month period. The goal is to use each injection to unlock rehab rather than to repeat indefinitely.
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Will I need physiotherapy afterwards?
Almost always. The injection buys a pain-free window; rehab in that window is what changes the underlying problem. We arrange the physio referral alongside the injection.
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When should I see a GP or A&E urgently after an ESI?
New saddle numbness, bladder or bowel change, bilateral leg weakness, a severe positional headache, fever, or spreading redness at the injection site needs urgent same-day review. Cauda equina symptoms are a 999 call.
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