Pottsville PA: Over the last few years, I have observed more and more of our patients coming into our office after they were to the “pain clinic” and had a steroid injection in their spine (Epidural is the medical term for this procedure). Not long ago in the Pottsville/Schuylkill county area, this treatment was almost unheard of for neck and back pain. Now it seems to be the recommendation of choice, even before more conservative treatment. And that is contrary to published guidelines.
Before you subject yourself to epidural (steroid injection) treatment for back or neck pain there are a few things you should know about it.
Steroid Injection For Acute Back and Leg Pain
In 1994, the Agency for Health Care Policy and Research of the U.S Department of Health and Human Services published a guideline titled Acute Low Back Problems in Adults: Assessment and Treatment. They defined acute to mean low back and leg pain from day 1 to less than 90 days duration.
In this study, they reviewed all the current literature and only took into consideration the most valid studies. There were 26 studies for epidural injections. What they published and recommend concerning epidurals may astonish you.
An epidural steroid injection was not a recommended treatment!
The report suggested an epidural (steroid injection) for sciatica (nerve pain down the leg) as an option only to avoid surgery! (There was at least one adequate study.)
The report recommended against an epidural injection just for back pain without sciatica!
Their recommendations concerning epidural injections have not changed in over twenty.
Epidural Steroid Injection For Chronic Back and Leg Pain
Chronic back pain is typically defined as pain more than 90 days duration.
In 2007, WebMD published an article titled; Steroid Shots for Back Pain Don’t Work. The American Academy of Neurology’s Therapeutics and Technology Assessment Subcommittee reviewed four studies on epidural injections for back pain with sciatica. What they found was epidural steroid injections:
- did not relieve back pain more than a placebo 24 hours, 3 months, or 6 months after injection,
- did not appear to improve the patients’ average back function, and
- did not help the patients avoid surgery.
There was a slight drop in pain 2 to 6 weeks after the injection compared with patients who got placebo injections, bit it was not “clinically meaningful”.
In short, the subcommittee advised against epidural injections for chronic back pain.
Our Experience and Recommendation
All interventions have risk; epidural injections are no exception. Although small, one risk is spinal infection. Unfortunately, one of our patients experienced this adverse reaction. Because of the infection from the steroid injection he was admitted to Gesinger for an extended stay and was cut neck to his buttock. Eventually the infection was stopped but he had scarring all along the spinal cord. He was told he would never walk again. When he came to our office, he was walking with a walker. He told me he was considered lucky. He was not expected to improve.
In light of the above, I have seen a few patients that have had their pain reduced by epidural steroid injection, some for a few weeks, and some for a few months. We have even recommended epidural injections when we thought it might be helpful as the patient was going through rehab for their back pain and sciatica problem.
Now that you know, if your doctor recommends an epidural injection for your back or neck pain talk to him or her about this information…. And Think Again.
Our recommendations are:
- If you have not failed conservative treatment for back and leg pain, such as anti-inflammatory medication with manipulation and physical therapy, do not do the steroid injection. Do the conservative treatment before considering and epidural steroid injection.
- If you just have neck or back pain there is not any evidence in the peer reviewed literature that suggest an epidural would be helpful, do not do it.
- If you have back and leg pain, failed at least 6 weeks of conservative treatment (no improvement in pain levels or function) and were told you need surgery, then there is some evidence that and epidural may provide some relief. The most recent consensus is that the epidural injection should be performed if you are also going through a exercise rehab program at the same time.
Want To Know More?
Doctors’ Choice Physical Medicine and Rehab
Dr. David Novatnak
Glee Pascual, Physical Therapist
Pottsville, Schuylkill, PA
You can find the clinicians U.S Department of Health and Human Services guideline at: http://www.chirobase.org/07Strategy/AHCPR/ahcprclinician.html
The WebMD article can be found at: