What is the efficacy of epidural corticosteroids for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Uncontrolled studies on the use of caudal epidural corticosteroids have shown benefit in 33-77% of patients. One study indicated no significant difference in outcome between a group of 24 patients treated with caudal injections of procaine 1% and methylprednisolone 80 mg and another group of 24 patients treated with procaine alone. Two additional studies purported to show that caudally administered LA mixed with corticosteroids yielded a clinical benefit, but comparison data were found to lack statistical significance. Another 3 studies reporting the same results were methodologically flawed. Overall, the published literature supports the therapeutic use of caudal epidural steroids for the treatment of radicular symptoms; however, the scientific evidence is weak.

On assessment, the published medical literature also is favorably disposed toward the use of lumbar epidural LA and corticosteroid combinations for radicular symptoms, although more negative studies have emerged evaluating the lumbar epidural approach than evaluating the caudal approach. Dilke et al studied 100 patients with unilateral sciatica who received either active treatment consisting of lumbar epidural injection of 40 mL of 0.75% lignocaine with 80 mg of methylprednisolone and 25 mg of hydrocortisone, or a control injection of 1 mg of isotonic saline solution into the interspinous ligament. Significantly, more patients receiving the active treatment had their pain "clearly relieved." Three months after treatment, a greater proportion of the active treatment group had no pain, took no analgesics, and had resumed work. However, some of the treatment group had undergone subsequent surgery or other nonsurgical treatments; these latter differences were not statistically significant.

Other randomized controlled studies have shown conflicting results and been attacked as methodologically flawed. Clinical judgment remains the mainstay of support for or against the use of lumbar epidural steroid injections. Some advocate their use in the early management of selected patients with sciatica or radiculopathy; however, benefits are usually temporary.


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