From the Guidelines
Epidural injections for pain management have a history dating back to the early 1900s, with significant evolution over the years, particularly with the introduction of corticosteroids in the 1950s and 1960s. The first documented use of epidural injections for pain relief occurred around 1901 by French physicians Jean-Athanase Sicard and Fernand Cathelin, who used cocaine injections through the sacral hiatus to treat sciatica and other painful conditions 1.
Key Developments in Epidural Injections
- The technique evolved with the introduction of local anesthetics like procaine or lidocaine, sometimes combined with saline.
- The addition of corticosteroids such as methylprednisolone, triamcinolone, or betamethasone significantly enhanced the therapeutic potential of these injections.
- Modern epidural injections involve fluoroscopic guidance for precise needle placement and are used for managing various spinal pain conditions, including back pain, persistent pain after spinal surgery, neuropathic pain, and complex regional pain syndrome, as mentioned in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1.
Current Practice and Recommendations
- Epidural steroid injections are specifically used for conditions like lumbar radiculopathy with herniated disc.
- The level of evidence for the effectiveness and risks of these procedures varies, and additional research is needed to establish the clinical benefits and risks compared to other treatments.
- It is crucial that interventional procedures, including epidural injections, are performed by properly trained clinicians following meticulous infection control protocols to minimize the risk of rare, serious adverse events. Clinicians are advised to consult with a qualified pain management specialist to determine the potential appropriateness of specific interventional procedures for their patients' indications and clinical circumstances 1.
From the Research
History of Epidural Injections
- Epidural injections have been used since 1901 in managing low back pain and sciatica, as stated in the study 2.
- The first injections were given around 1900 in Paris by Jean Sicard and Fernand Cathelin, who worked independently, injecting small volumes of cocaine into the sacral hiatus, according to the study 3.
Evolution of Epidural Injections
- After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America, as mentioned in the study 3.
- In the early 1950s, corticosteroids were introduced for epidural use, as stated in the study 3.
- Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term, according to the study 3.
Current Use of Epidural Injections
- Epidural injections are widely accepted as a valuable modality for perioperative pain management, as stated in the study 4.
- Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, supported by more than 45 placebo-controlled studies and dozens of systematic reviews, according to the study 5.