Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
Most practitioners will agree that, while the effects of the injection tend to be temporary - providing relief from pain for one week up to one year - an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program. If the initial injection is effective for a patient, he or she may have up to three in a one-year period.
In addition to the low back (the lumbar region), epidural steroid injections are used to ease pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.
This article focuses on epidural injections in the low back area used to treat low back pain and radicular pain (also referred to as leg pain or sciatica).
Although many studies document the short-term benefits of epidural steroid injections, the data on long-term effectiveness are less convincing. Indeed, the effectiveness of lumbar epidural steroid injections continues to be a topic of debate. This is accentuated by the lack of properly performed studies.
For example, many studies do not include use of fluoroscopy or X-ray to verify proper placement of the medication despite the fact that fluoroscopic guidance is routinely used today. Additionally, many studies do not classify patients according to diagnosis and tend to 'lump' different types sources of pain together. These methodological flaws tend to make interpretation and application of study results difficult to impossible.
More studies are needed to properly define the role of epidural steroid injections in low back pain and in sciatica. Despite this, most studies report that more than 50% of patients find measurable pain relief with epidural steroid injections. They also underscore the need for patients to enlist the services of professionals with extensive experience administering injections, and who always use fluoroscopy to ensure accurate placement.
Epidural steroid injections deliver medication directly (or very near) the source of pain generation. In contrast, oral steroids and painkillers have a dispersed, less-focused impact and may have unacceptable side effects. Additionally, since the vast majority of pain stems from chemical inflammation, an epidural steroid injection can help control local inflammation while also "flushing out" inflammatory proteins and chemicals from the local area that may contribute to and exacerbate pain.