What is the rationale for use of epidural steroids in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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The rationale for use of epidural steroids was based on the belief and some supporting literature, including animal studies, that lumbosacral radiculopathies may have an inflammatory component. [17] A study performed by Ryan and Taylor arbitrarily divided 70 patients into 2 groups -- those with "compressive radiculopathy" and those with "irritative radiculopathy." The former group was characterized by sciatica with sensory, motor, and reflex disturbances, while the latter was characterized by sciatica alone. Intrathecal and epidural injections of corticosteroids produced better therapeutic responses in the group with "irritative radiculopathy." Furthermore, responders tended to have higher CSF protein levels and a shorter duration of illness, particularly with sciatica lasting less than 2 weeks. [18]

Therefore, epidural corticosteroids may provide relief in some cases of radiculopathy owing to their anti-inflammatory properties; however, research has demonstrated that methylprednisolone has a direct inhibitory action upon nociceptive input. In summary, many practitioners advocate the use of epidural corticosteroids as treatment for inflammatory-type radicular pain and preclude their use for axial or referred somatic pain. Since nerve root inflammation has not been implicated as the only cause of back pain, no confirming data exist to support the use of epidural steroids for low back pain alone.

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