What is the optimal timing of epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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The optimal timing of epidural injection is unknown. Patients with radicular symptoms often undergo a few weeks of treatment, including relative rest or activity modification, medication, physical therapy, and/or manual therapy, prior to undergoing epidural injections. If the patient does not have success with such a program or if the therapy cannot progress because the patient's pain is too severe (as long as there are no signs of progressive neurologic deficits), epidural injection is indicated for pain control.

In contrast, early use of epidural steroid injections (ESIs) can be considered in patients with severe radicular pain that does not respond even to opioid medication or in whom the pain is severely interfering with sleep habits and daily functioning. Early ESIs also carry the theoretical benefit of controlling inflammation at the early stage and of preventing permanent neural damage, such as nerve fibrosis from the prolonged inflammatory process. Under these circumstances, early administration of ESIs may have a more beneficial effect than would later/delayed use.

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