How effective are epidural steroid injections for Pain Relief?

Epidural steroid injections are one of the most common pain management procedures performed in the US today. For over 50 years, they have been the gold standard for the treatment of sciatica and spinal stenosis. Really, anytime a nerve gets pinched in the neck or back, an epidural steroid injection is the “go to” procedure.

How well do they work?

There have been dozens of studies looking at the effectiveness of epidural injections for pain relief. It is very important to weed out the poorly performed studies so as not to confuse the results.

For instance, a lot of earlier studies looking at epidural steroid injections did not include image guidance. It is now known that up to 30% of epidural injections are placed inaccurately without image guidance.

Therefore, modern Seattle pain management doctors use image guidance with either fluoroscopy or ultrasound to make sure the medication is being injected accurately. Therefore, only studies that include image guidance should be evaluated.

When looking at studies performed in a prospective, randomized fashion, there are still over a dozen to evaluate. Results have consistently shown 50 to 90% excellent pain relief with epidural steroid injections for both sciatica and spinal stenosis. This includes all three types of epidural steroid injections, including interlaminar, transforaminal and caudal.

What this means is that most patients are able to achieve pain relief and avoid the need for potentially risky spine surgery with the procedures.

There are those who like to lambast epidural injections as they are not FDA approved in the spine. This is actually ridiculous, as 40% of medications in America are frequently used off label. Such medications as Neurontin for nerve pain relief and propranolol for performance anxiety. This has nothing to do with whether or not the medication is effective.