From the Guidelines
Epidural steroid injections are a treatment option for back pain, particularly for conditions like herniated discs, spinal stenosis, or radiculopathy, as they can provide temporary pain relief and improved function. These injections typically consist of a corticosteroid medication combined with a local anesthetic, which works by reducing inflammation and suppressing immune responses that cause pain and swelling around compressed or irritated nerves 1. The effects of epidural steroid injections can last from a few days to several months, and patients may receive a series of injections spaced several weeks apart.
Key Points to Consider
- Epidural steroid injections are commonly used for conditions like herniated discs, spinal stenosis, or radiculopathy, as they can provide significant temporary pain relief and improved function 1.
- The procedure involves injecting a medication mixture into the epidural space surrounding the spinal cord and nerve roots, which reduces inflammation and suppresses immune responses that cause pain and swelling around compressed or irritated nerves.
- Side effects can include temporary pain at the injection site, headaches, and rarely, infection or bleeding 1.
- While epidural steroid injections don't cure the underlying condition, they can provide temporary pain relief and improved function, allowing patients to participate in physical therapy and rehabilitation.
Recommendations
- Epidural steroid injections should be considered for patients with low back pain who have not improved with self-care options and are potential candidates for surgery or epidural steroid injection 1.
- Clinicians should assess the severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
- Patients should be informed about the potential benefits and risks of epidural steroid injections, as well as the importance of combining injections with other treatments, such as physical therapy and rehabilitation, to achieve optimal outcomes.
From the Research
Epidural Steroid Injections for Back Pain
- Epidural steroid injections are used to treat low back and radicular pain, with studies showing their effectiveness in providing short-term pain relief 2, 3.
- The injections typically involve administering a steroid medication, such as methylprednisolone, into the epidural space to reduce inflammation and relieve pain 2, 4.
- The procedure is considered safe and minimally invasive, with a low risk of major complications 2, 3.
Indications and Efficacy
- Epidural steroid injections are commonly used to treat patients with symptomatic herniated lumbar discs, lumbar spinal stenosis, and sciatica 2, 3, 5.
- The efficacy of epidural steroid injections has been established in several studies, with some showing significant improvements in pain and functional status 2, 3, 4.
- However, the duration of benefit can be limited, and some studies have suggested that the injections may not provide long-term relief 4, 6.
Clinical Applications
- Epidural steroid injections are often used as a treatment option for patients with back and leg pain who have not responded to conservative treatment 2, 3.
- The injections can be used to delay or avoid surgical intervention in some cases, and may be particularly beneficial for patients with radicular pain 4, 5.
- Recent studies have investigated the optimal timing and number of injections, with some suggesting that multiple injections may not provide additional benefit 6.