What conditions do epidurals treat?

Conditions Treated by Epidural Injections

Epidural injections are primarily effective for treating low back pain with radiculopathy, spinal stenosis, and certain types of neuropathic pain conditions, particularly when there is clear correlation between imaging findings and symptoms. 1, 2

Primary Indications for Epidural Injections

Radicular Pain Conditions

• Lumbar radiculopathy/sciatica: High-quality evidence supports epidural blockade for treating low back pain with lower-extremity radicular symptoms 1
• Cervical radiculopathy: Moderate evidence supports cervical interlaminar epidural injections for patients with radicular pain 2
• Lumbosacral radiculopathy: Neural blockade can be effectively used for this condition, especially when related to disc herniation 1, 3

Spinal Stenosis

• Epidural injections show fair evidence for effectiveness in treating pain from spinal stenosis 2, 3
• Most beneficial when there is a clear radicular component to the pain 2

Neuropathic Pain Conditions

• Cancer-related neuropathic pain: Particularly effective when there is intercostal nerve involvement 1
• Post-herpetic neuralgia: May respond to epidural injections when other treatments have failed 4

Specific Pain Patterns That Respond Best

1. Radicular pain patterns that follow a dermatomal distribution
2. Pain with imaging correlation - MRI evidence showing nerve compression at the target level 2
3. Failed conservative management - Patients who have not responded to at least 4 weeks of conservative treatment 2

Effectiveness Based on Pain Location

Pain Condition	Level of Evidence	Recommendation
Lumbar disc herniation with radiculopathy	Good/Strong	First-line interventional option [3,4]
Spinal stenosis with radicular symptoms	Fair/Moderate	Consider after conservative failure [2,3]
Cervical radiculopathy	Moderate	Effective option with proper technique [2,4]
Axial back pain without radiculopathy	Poor/Limited	Not recommended as primary treatment [3,5]
Post-lumbar surgery syndrome	Limited/Moderate	May provide relief in selected cases [3,4]

Important Considerations and Caveats

Patient Selection Criteria

• Epidural injections should be reserved for patients with:
  • Confirmed radiculopathy with imaging correlation
  • Failed conservative management (>4 weeks)
  • No contraindications to the procedure 2

Risk Considerations

• Serious adverse events are rare but have been reported with epidural injections 1
• Potential complications include spinal cord injury, respiratory complications, and in extremely rare cases, paralysis 2
• The interlaminar approach is generally preferred over transforaminal for cervical injections due to lower risk of catastrophic complications 2

Procedural Approach

• Fluoroscopic guidance is essential for accurate needle placement 2
• Epidurography should be used to confirm proper needle position before medication injection 2
• For upper body pain, epidural catheters should be inserted between T5 and T8 root levels 1

Limitations of Effectiveness

• Up to one-third of epidurals may not function satisfactorily in some centers 1
• Multiple epidural steroid injections before more definitive procedures may not improve outcomes and may delay appropriate care 6
• Not recommended for nonspecific back pain without radicular symptoms 2

Epidural injections should be part of a comprehensive treatment approach that includes physical therapy and appropriate medication management to maximize functional outcomes and quality of life for patients with radicular pain conditions.