What is the efficacy of epidural steroid 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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Answer

Answer

Based on the available evidence, the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology found that epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared with control treatments. However, the magnitude of improvement was small and no meaningful impact could be measured in regard to improved function, the need for surgery or pain relief beyond 3 months. The subcommittee concluded that the medical literature showed faulty methodology in general, and so evidence was insufficient to support the use of lumbar epidural steroid injections (LESIs) in clinical practice. [175]

Based on the literature support, or lack thereof, the debate regarding the use and benefit of epidural steroid injections for spinal pain patients will continue. At present, most evidence-based data show strong literature support for the use of caudal, intralaminar, and transforaminal corticosteroid epidural injections to provide short-term pain relief for lumbar radicular syndromes, even chronic cases, but this treatment is best reserved for use as an adjunctive therapy or during a flare-up of symptoms. [136, 176]

Given that the medical literature is flawed, whether to use this procedure or not in specific cases depends on one's clinical experience and judgment as to the rationale, predicted efficacy, and patient safety. No clear evidence shows that these procedures provide long-term pain relief. Epidural injections may be useful as a method of pain control in the short-term and may provide benefits as an adjunct to other therapies. No evidence supports the use of LESIs for axial LBP, but sketchy evidence supports the use of LESIs in patients with lumbosacral radiculopathy.


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