What is the efficacy of epidural injections in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Evidence synthesis by Manchikanti involved a review of 8 randomized or double-blind trials. Five supported short-term relief [155, 156, 157, 158, 159] (defined as < 3 mo) and 5 also supported long-term relief (defined as >3 mo) when a caudal injection approach was used. [155, 157, 158, 159, 160] In addition, 3 prospective [161, 162, 163] and 4 retrospective trials [164, 165, 166, 167] demonstrated support for short- and long-term pain relief when epidural injections were performed in a series, rather than having just a single injection. An evidence synthesis for intralaminar epidural injections by Manchikanti et al showed 7 of 10 randomized trials positive for short-term relief, and 3 for long-term relief. [137] Numerous nonrandomized trials showed patients benefiting from cervical or lumbar intralaminar epidural steroid injections. [137]

At present, the literature strongly supports the use of intralaminar corticosteroid epidural injections for providing short-term pain relief when treating cervical or lumbar radicular syndromes, even chronic cases; therefore, this treatment is best reserved for use as an adjunctive therapy or during a flare-up of symptoms. [137]

Reviews by Koes et al in 1995 and 1999 supported the usefulness of lumbar and caudal epidural injections for LBP and sciatica. [168] Meta-analyses in 1995 by Watts and Silagy [169] and in 1998 by van Tulder et al [170] reported conflicting evidence and inconsistent findings regarding the effectiveness of epidural steroids. A 1998 review of the literature [171] concluded that epidural corticosteroid injections were effective for back pain and sciatica, and subsequently, a 2000 review by Vroomen et al cited epidural steroids as beneficial for some patients with nerve root compression and sciatica. [172]

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