Epidural steroid injections have been used for pain relief since 1952. When indicated, they are an invaluable nonsurgical treatment for low back pain radiating to the lower extremities and for neck pain radiating to the arms. Since the 1950’s epidural steroid injections have been used to treat pain caused by nerve impingement. These injections are often used in treating radicular pain, a neuropathic pain syndrome that radiates down a dermatome of 1 or more spinal nerves. Typically, the pain is due to nerve root irritation from mechanical compression by an intervertebral herniated disc, leading to inflammation. Performing an effective epidural steroid injection requires the steroids to reach the epidural space.
Successful epidural steroid injections provide pain relief, restoring function and return to physical rehabilitation exercises.
The 3 primary epidural steroid injections are transforaminal, interlaminar, and caudal. Epidural steroid injections are done with topical local anesthesia or under intravenous sedation. Epidural steroid injections effectively treat lumbosacral radicular pain (sciatica), or radicular pain from the neck into the arms. In certain cases, an epidural can bypass the need for surgical intervention. Recent studies, including several reviews and meta-analyses, have shown that transforaminal and interlaminar epidural steroid injections can provide reliable pain relief for patients with low back pain associated with radicular (nerve root) symptoms. In some cases, epidural steroid injections can provide long-term benefits lasting up to 12 months and prolong the need for surgery.
In patients with lumbosacral radiculopathy, more than half of the patients report interference in activities of daily living, and 25% continue to have severe pain that does not respond well to medications.
Approximately 14% of patients with lumbosacral radiculopathy eventually require surgery for severe pain. However, in many cases, radicular pain secondary to intervertebral disc herniation improves with medical and rehabilitative treatment. Steroid injection into the epidural space is used to achieve inflammation reduction and pain relief and limit medications or surgery. The efficacy of epidural steroid injections in lumbosacral radiculopathy has been widely studied and moderate-quality evidence demonstrates that transforaminal epidural steroid injections can be used to reduce pain up to 3 months. Cervical epidural steroid injections have been shown to provide short-term relief for radicular cervical pain, but long-term outcomes need more data. Limited high-quality evidence suggests that cervical epidural steroid injections can be beneficial for radiculitis secondary to disc herniation and discogenic pain.
Studies on cervical epidural steroid injections demonstrate evidence of pain relief and improvement lasting 12 to 24 months.
Several studies required multiple injections, and similar efficacy exists between epidural steroid injections with local anesthetics versus local anesthetics alone. The indications included radicular pain, disk herniation, cervical spinal stenosis, and cervical post-surgery syndrome.
Epidural steroid injections are a potent tool for managing chronic pain. These procedures require care coordination from a skilled team to ensure patient-centered care, optimal outcomes, and safety. Successful administration of epidural steroid injections hinges on the specialized skills and strategic planning of clinicians trained in pain management procedures. To make the most of the beneficial effects of an epidural steroid injection, it is paramount to restore proper mechanics and mobility through targeted rehab exercises.
Other critical components include patient education on lifestyle changes such as regular exercise, maintaining a healthy weight, and avoiding a sedentary lifestyle are essential for long term success.
For best outcomes, follow up with your physician, your care team, and actively engage in your own rehab.
References:
National Institute of Health, National Library of Medicine. Ketan Patel; Pooja Chopra; Seth Martinez; Sekhar Upadhyayula.
https://www.ncbi.nlm.nih.gov/books/NBK470189
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