What is the frequency 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 interval between injections varies with the steroid preparation used. Because injected methylprednisolone has been reported to remain in situ for approximately 2 weeks, the clinician should consider waiting approximately 2 weeks after the injection to assess the patient's response and to determine if it would likely be beneficial to administer a repeat injection. However, this 2-week interval may be reduced if a different (short-acting) steroid is used or if the clinical scenario warrants an earlier performance of the repeat epidural. In general, however, routine performance of a predetermined fixed number of epidural injections without a clinical reevaluation in between injection procedures should be discouraged.

The ideal number of epidural injections to be administered for a given clinical scenario is often unclear, because data in the current literature are not clear on the exact number of ESIs to be administered and the timing that should be used. Clinical practice patterns, however, suggest that up to 3-4 injections may be used for acute radicular pain syndromes. Reevaluation by a physician after each injection seems to be indicated to determine the need for additional procedures prior to pursuing a series of 3 epidural injections, regardless of clinical response, since there are no medical outcome studies to clearly support such a regimen.

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