Epidural Steroid Injections: What Current Evidence Suggests

The main reason epidural steroids are used is for neuropathic pain. Since 1953, epidural steroid injections have been used for lumbar radiculopathy to reduce proinflammatory chemical agents.¹ However, “[t]hirty-five controlled studies on the subject have failed to provide a definitive answer regarding the efficacy of epidural steroid injections and it is unlikely that future trials will do so.”² In short, the evidence recommending steroid injections is still unclear.

Neurogenic pain is symptomatically described as “shooting or stabbing” pain caused by nerve root involvement. Pain usually extends below the knee. For disc problems, prolonged sitting or forward flexion may be more aggravating. Spinal Stenosis is included as a neurogenic problem.

 In a 2011 article published in the British Medical Journal,⁴ the authors concluded that “neither caudal epidural steroid injections nor caudal epidural saline injections are effective for chronic lumbar radiculopathy and are not recommended as an adjunct to recovery in patients whose symptoms have extended beyond 12 weeks.”

In an editorial discussing this article,² the author states that epidural steroids should be considered as part of a multidisciplinary treatment plan, especially with acute or subacute radiculopathy secondary to a herniated disc when more conservative measures have failed. He also recommends the injection for chronic or unremitting pain, non-radicular pain and spinal stenosis, although he feels more numbers of these types of patients are needed for validation in future studies.

Often up to three injections are recommended. Yes, there may be side effects, such as temporary numbness of the bowels and bladder, infection and a puncture of the dura with a severe headache.

Spinal Decompression Therapy is a drugless healing method always looking for causation rather than symptomatic relief, but as we must realize, there is a time and place for medical relief. In those unresolved cases with unremitting pain, I would recommend the procedure.

For more information on spinal decompression therapy, visit us at www.vanspinaldecompression.com

References

1. Goupille P, Jayson MI, Valat JP, Freemont AJ. The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum, 1998;28:60-71.
2. Cohen SP. Epidural steroid injections for low back pain. (Editorial) BMJ, 2011;343:1-2
3. Cohen SP, Argoff CE, Carragee EJ. Management of low back pain - clinical review. BMJ, 2009;338:100-106.
4. Iversen T, Solberg TK, Romner B, Wilsgaard T, et al. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomized controlled trial. BMJ, 2011;343:1-15.
5. DePalma MJ, Slipman CW. Evidence-informed management of chronic low back pain with epidural steroid injections. Spine, 2008;8:45-55.