What is the recommended approach for intramuscular (IM) injections in managing lumbar radiculopathy (lombosciatalgia)?

Intramuscular Injections for Lombosciatalgia Are Not Recommended

Intramuscular injections are strongly NOT recommended for managing lumbar radiculopathy (lombosciatalgia) as they have not demonstrated long-lasting benefit and are explicitly discouraged in current high-quality clinical guidelines. 1

Evidence Against Intramuscular Injections for Lombosciatalgia

The most recent and highest quality evidence from the 2025 BMJ clinical practice guideline on interventional procedures for non-cancer chronic spine pain explicitly issues a strong recommendation against intramuscular injection of local anesthetic with or without steroids for chronic spine pain 1. This recommendation applies to both axial spine pain and radicular pain conditions like lombosciatalgia.

Similarly, the 2014 Journal of Neurosurgery guidelines specifically state that trigger point injections performed as dry needling, with anesthetics alone or with steroids, are not recommended in patients with chronic low-back pain without radiculopathy because long-lasting benefits have not been demonstrated (Level II evidence) 1.

The 2020 British Journal of Sports Medicine systematic review of high-quality clinical practice guidelines also recommends against spinal injections (including trigger point injections) for low back pain 1.

Alternative Evidence-Based Approaches for Lombosciatalgia

Instead of intramuscular injections, consider these evidence-based approaches:

1. Non-pharmacological interventions:

   • Self-management programs
   • Exercise therapy
   • Physical therapy focusing on core strengthening and flexibility

2. Pharmacological options (when appropriate):

   • NSAIDs like ketorolac may be used for short-term pain management (≤5 days) 2
   • Note: Opioids are not recommended for chronic low back pain 1

Technical Considerations If IM Injection Is Absolutely Necessary

Despite the strong recommendations against intramuscular injections for lombosciatalgia, if clinical judgment determines an exceptional case where short-term pain relief is absolutely necessary:

• Proper technique is essential:

  • Select appropriate needle length based on patient's body mass index 3
  • Ensure delivery into muscle tissue rather than subcutaneous tissue 3
  • Administer slowly and deeply into the muscle 2
  • Consider applying pressure to the site for 10 seconds prior to injection to reduce pain 4

• Site selection:

  • Ventrogluteal site is generally preferred over dorsogluteal due to lower risk of nerve injury
  • Dorsogluteal site may be used when specified in drug package insert, clinical need, nursing judgment, or patient preference 5

• Patient monitoring:

  • Monitor for at least 15 minutes post-injection for adverse effects 3
  • Position patient to lie down if lightheadedness occurs 3

Important Cautions

• Intramuscular corticosteroid administration can cause systemic side effects including cardiovascular effects, flushing, headache, and nausea 3
• Patients with cardiovascular disease may be at higher risk for adverse reactions 3
• Diabetic patients may experience hyperglycemia following corticosteroid administration 3

Conclusion

The current high-quality evidence strongly recommends against using intramuscular injections for managing lombosciatalgia. Clinicians should instead focus on evidence-based approaches including exercise therapy, physical therapy, and appropriate short-term use of NSAIDs when necessary.