Epidural steroid injections – Worth the Risk?

As we examine the role of epidural steroid injections (ESI) in the recent illnesses and death from spinal meningitis, the first question to ask is what does science say about the effectiveness of ESI in relieving back pain.

A number of studies have been done on patients exhibiting chronic back pain with radicular symptoms (pain radiating down the leg). Test subjects are usually divided into two groups; one receives a local anesthetic while the other group receives an anesthetic and a steroid.  Most studies measure effectiveness at given intervals after treatment (e.g. 3, 6 and 12 months) and evaluate subjective pain, assess disability status and determine return to work.

Most studies conclude that ESI is sometimes effective (about 50%) in the short term, significantly less effective in the long-term.  Almost always, a patient’s status relative to pain, disability, return to work, etc. is essentially the same after a period of time (e.g. 12 months) regardless of whether he/she received a steroid or a placebo.

So, there may be short-term relief, but there is rarely long-term relief.  We have known for a while a number of potential complications associated with injecting a needle into the spinal canal. One must wonder if the short-term relief justifies the risks.

Does your UR vendor ever question the effectiveness or medical necessity of ESI or other pain management procedures?

Do your medical management professionals ever discuss potential complications and side effects with the treating provider?

We do!