Epidural Steroid Injections Ineffective Save
A meta-analysis of 30 placebo-controlled trials evaluated epidural corticosteroid injections for radiculopathy, and 8 trials were done for spinal stenosis. Corticosteroid injections offer limited or no relief from radiculopathy and spinal stenosis, two leadin causes of back pain that are often treated with steroid injections.
For radiculopathy, epidural corticosteroids were associated with greater immediate improvement in pain intensity compared to placebo, but effects were small and short-lived. There seemed to be no effect on preventing surgery in the long-term. For spinal stenosis, epidural corticosteroids seemed to have no clear effect on patient outcomes.
The small and unsustained benefits of epidural corticosteroid injections was not associated with any long-term benefits, thus questioning the risk vs.benefit of epidural injections.
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Many of use who treat spinal stenosis and lumbar radiculopathy would disagree with this. A big problem with many of the studies and the meta-analysis is that they are asking the wrong question. I send patients with lumbar spinal stenosis and DDD or OA of the back who have lumbar radicular pain who have failed all other therapies (PT, NSAIDs, neuropathic analgesics), and as previous studies suggest, a significant number do obtain significant improvement in pain while they failed everything else. Many of these studies are looking at long term pain relief, which is not how I present it to my patients (I present it as a therapy which may offer short term pain improvement that can be repeated in the future if it works .... as an alternative to surgery).
DT. I agree. Our motivation is our patients needs - relief now! Payers and guidelines people will look at this and say do something else, but offer no superior short term and long term options!
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