Epidural injection for back pain

Epidural injections of (cortico)steroids: there is no evidence that this is effective in treating acute radiculopathy. ¹⁾.

Most studies that show benefit are retrospective and noncontrolled. Prospective studies yield varied results ²⁾.

Some improvement at 3 & 6 weeks may occur (but no functional benefit, and no change in the need for surgery), with no benefit at 3 months ³⁾.

The response to chronic back pain is poor in comparison to acute pain. ESI may be an option for short-term relief of radicular pain when a control on oral medications is inadequate or for patients who are not surgical candidates

b) there is no evidence to support the use of epidural injections of steroids,local anesthetics and/or opioids for LBP without radiculopathy

c) reports on efficacy with conditions such as lumbar spinal stenosis are conflicting, ⁴⁾ relief is almost uniformly temporary (4–6 weeks with initial injection, shorter times with subsequent ones)

¹⁾

Cuckler JM, Bernini PA, Wiesel SW, et al. The Use of Epidural Steroids in the Treatment of Lumbar Radicular Pain. A Prospective, Randomized, Double-Blind Study. J Bone Joint Surg. 1985; 67A: 63–66

²⁾ , ⁴⁾

Spaccarelli KC. Lumbar and Caudal Epidural Corticosteroid Injections. Mayo Clin Proc. 1996; 71:169–178

³⁾

Carette S, Leclaire R, Marcoux S, et al. Epidural Corticosteroid Injections for Sciatica due to Herniated Nucleus Pulposus. N Engl J Med. 1997; 336:1634–1640