In order to minimize patient anxiety and maximize patient comfort, pain practitioners frequently administer sedatives when performing spine injections. The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections and the potential risk of neurologic injury in patients undergoing injection treatments while sedated represent major barriers to the development of safe, tailored sedation practices. This prospective observational cohort study was conducted with injection-naïve patients presenting for a routine cervical or lumbar epidural steroid injection for a pain related indication at a tertiary urban academic medical center to measure and compare anxiety levels in order to identify predictors of patient movement and vasovagal responses. Anxiety was measured using validated outcomes. The primary outcome measure was the Spielberger State Trait Anxiety Inventory (STAI) score. Numeric rating scale (NRS) for anxiety was also used. A two-sample Wilcoxon rank-sum test was used to compare STAI scores. NRS was analyzed with ANOVA and categorical variables were evaluated by using an c2 statistic. We found no group differences in age, gender, marital status, VAS pain score, duration of pain symptoms, or utilization of healthcare resources for pain symptom management. The mean STAI score was 43 ± 8 in the cervical group (n =139) and 44 ± 9 in the lumbar group (n = 140) (p = 0.35), a low level of anxiety (the lowest possible score is 20, and the highest score, representing the highest possible level of anxiety is 80). We found no between-group differences in anxiety at any point during the peri-procedure period. A vasovagal response was identified in 10% of the cervical group and in 3% of the lumbar group (p=0.04). Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naïve general population should be re-evaluated. In order to minimize patient anxiety and maximize patient comfort, pain practitioners frequently administer sedatives when performing spine injections. The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections and the potential risk of neurologic injury in patients undergoing injection treatments while sedated represent major barriers to the development of safe, tailored sedation practices. This prospective observational cohort study was conducted with injection-naïve patients presenting for a routine cervical or lumbar epidural steroid injection for a pain related indication at a tertiary urban academic medical center to measure and compare anxiety levels in order to identify predictors of patient movement and vasovagal responses. Anxiety was measured using validated outcomes. The primary outcome measure was the Spielberger State Trait Anxiety Inventory (STAI) score. Numeric rating scale (NRS) for anxiety was also used. A two-sample Wilcoxon rank-sum test was used to compare STAI scores. NRS was analyzed with ANOVA and categorical variables were evaluated by using an c2 statistic. We found no group differences in age, gender, marital status, VAS pain score, duration of pain symptoms, or utilization of healthcare resources for pain symptom management. The mean STAI score was 43 ± 8 in the cervical group (n =139) and 44 ± 9 in the lumbar group (n = 140) (p = 0.35), a low level of anxiety (the lowest possible score is 20, and the highest score, representing the highest possible level of anxiety is 80). We found no between-group differences in anxiety at any point during the peri-procedure period. A vasovagal response was identified in 10% of the cervical group and in 3% of the lumbar group (p=0.04). Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naïve general population should be re-evaluated.