Are epidural steroid injections for low back pain a failure?

Epidural steroid injections (ESIs) are routinely touted as a common, minimally invasive, and effective treatment for low back and radiating leg pain.[1]  Though typically safe, steroid injections are not without risk. Anxiety, nausea, restlessness, high blood pressure, and potential infection, including fungal meningitis, are reported potential side effects of lumbar spine steroid injections.[2]

Physicians routinely perform ESIs for patients suffering from lumbar spinal stenosis, disc herniations, and other spinal conditions. An ESI is an injection of a mixture of a steroid anti-inflammatory and a local anesthetic into the epidural space encasing the spinal cord and nerves. The anesthetic provides short-term pain relief; the steroid anti-inflammatory purportedly alleviates discomfort for a longer period of time.

A recent study reported by the Journal of Bone and Joint Surgery indicates ESIs with a steroid-anesthetic mixture provide no greater relief than injections with local anesthetic alone.[3] The researchers conducted a randomized,  double-blind study of 400 patients with lumbar spinal stenosis. One set of 200 patients received injections of glucocorticoid (the steroid anti-inflammatory) and lidocaine (the local anesthetic), while another 200 patients received injections of lidocaine alone. The results revealed no significant difference. Patients injected with a steroid-anesthetic mixture had no greater improvements in pain-related functional disability or reported pain intensity than patients injected with  anesthetic alone. The anticipated longer-term relief with use of the steroid did not occur.

Additional research is needed to corroborate the study results; however, lack of symptomatic improvement gives pause to consider whether EPIs for low back pain are worth the potential risks.

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[1] Baker, Ray, Epidural Steroid Injections, KnowYourBack.Org, North American Spine Society, July 17, 2009;
Berger, Thomas, et al., Epidural Steroid Injection (ESI), Mayfield Clinic for Brian & Spine, Feb 2015;
Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA, Epidural Steroid Injections,  Medscape, December 23, 2014;
Staehler, Richard A., Lumbar Epidural Steroid Injections for Low Back Pain and Sciatica, Spine-Health, (Published: 1 Nov 1999; Updated: 17 Jul 2007);
Epidural Steroid Injection, Medicine, 14 Feb 2014;
Epidural Steroid Injection, The Spine Center, Columbia University Medical Center, Feb 2015.

[2] Tests and Procedures: Cortisone Shots, 13 Aug 2013;
Benefits & Risks, Remedy’s, (Published: 29 Jul 2013; Updated:  23 Apr 2014);
Multistate Outbreak of Fungal Meningitis and Other Infections, Centers for Disease Control and Prevention, 23 Oct 2013.

[3] Kepler, Christopher, et al., Epidural Injections with Glucocorticoid and Lidocaine for Spinal Stenosis Did Not Confer Additional Benefits Compared with Lidocaine Alone, J Bone Joint Surg Am 2015; 97:342 (18 Feb 2015).