Epidural Steroid Injection Treatment
Epidural steroid injections (ESIs) are a common treatment option for many forms of lower back pain and leg pain. They have been used for decades and are considered an integral part of the nonsurgical management of sciatica and lower back pain.
The injection is named an epidural steroid injection because it involves injecting a local anesthetic and a steroid medication directly into the epidural space that surrounds the spinal cord and nerve roots.
The goals of an epidural steroid injection are to:
- Control pain by reducing inflammation in and around the nerve roots
- Improve mobility and function in the lower back and legs1
- Allow the patient to participate in and make progress with a comprehensive physical therapy and rehabilitation program
- In the course of one’s care program, in most cases, an epidural steroid injection may be recommended after a series of nonsurgical treatments, such as medications and physical therapy,2 have been tried, and before surgery is considered.
- The role of the injection is typically to provide sufficient pain relief to allow a return to everyday activities and to make progress in physical therapy.
Most practitioners will agree that an epidural injection can be beneficial during an acute episode of back and/or leg pain. The main drawbacks of the injections are that they are not always effective, and when effective, the pain relief tends to be temporary, ranging from one week to one year. Typically, if the initial injection is effective, up to 3 injections may be given in one year.
When administered in the lumbar epidural space, steroid injections may have the following benefits:
- Reduce nerve pain and inflammation. Steroids decrease the production of inflammatory chemicals and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals.
- Limit oral medication. Pain relief from these injections may help limit or eliminate the need for oral medications,4 some of which may have side effects when taken long-term.
- Continue or re-engage in physical therapy. This injection may provide sufficient pain relief to allow a patient to progress with a rehabilitative physical therapy program.1
- Postpone surgery. Pain relief experienced from lumbar epidural steroid injections may help postpone surgery, and if physical therapy is effective, it may eliminate the need for surgical intervention.
Available research indicates generally favorable results, with 70% to 90% of patients experiencing pain relief from these injections, lasting for a week to a year. If a good first response is seen, a second injection may be considered when the improvement from the first injection begins to taper off. Typically, up to 3 injections may be given over a 12-month period.
Lumbar epidural injections are typically used in the treatment of conditions that cause irritation and/or inflammation of spinal nerve roots with associated lower back and leg pain. Most common lower back conditions treated include:
- Lumbar Herniated disc(s)
- Lumbar Degenerative disc disease
- Lumbar Spinal stenosis
Less commonly, localized back pain (axial back pain) and neurogenic claudication (back pain and leg pain that occurs while walking) may be treated with these injections.