Evaluation of Epidural Steroid Injections for Managing Chronic Back Pain

The American Academy of Neurology (AAN) has published a systematic review aimed at summarizing the effectiveness of epidural steroid injections in alleviating chronic back pain, particularly for specific conditions affecting the spine. This review appears in the journal Neurology and serves as an update to a previous assessment conducted in 2007.

Epidural steroid injections involve administering corticosteroid medication into the epidural space of the spine, with the intention of providing relief from certain types of back pain. Chronic back pain is a prevalent issue that can significantly impair an individual's quality of life, impacting their mobility, sleep patterns, and ability to engage in daily activities.

The review indicates that while epidural steroid injections may have limited effectiveness, there is evidence suggesting they can provide modest pain relief for certain patients. Specifically, the injections may reduce pain for a duration of up to three months and improve disability for some individuals for six months or longer.

In analyzing a comprehensive dataset over a span of 16 years, researchers evaluated 90 different studies focused on the application of epidural steroid injections for two primary conditions: radiculopathy and spinal stenosis. Radiculopathy is characterized by nerve compression in the spine, while spinal stenosis involves narrowing of the spinal canal, resulting in nerve compression.

Findings for patients with radiculopathy reveal that epidural steroid injections could lead to a modest reduction in both pain and disability for up to three months post-procedure. Data indicated that 24% more patients receiving this treatment reported a decrease in pain compared to those who did not undergo the procedure, with 16% reporting reduced disability within the same timeframe. Furthermore, a notable 11% of patients continued to report decreased disability for up to six months or longer.

However, it is important to note that the majority of these studies focused on lower back radiculopathy, leaving a gap in understanding the treatment's effectiveness for radiculopathy affecting the neck.

Regarding spinal stenosis, the analysis suggested that epidural steroid injections might offer some benefit in lowering disability levels for up to six months or longer after treatment. Compared to those who did not receive the injections, 26% more patients experienced reduced disability within three months, and 12% reported continued improvement for six months or beyond. However, the treatment did not demonstrate a significant effect on pain reduction during the same periods.

Again, the studies primarily examined patients with lower back spinal stenosis, resulting in uncertainty about the treatment's efficacy for those with neck-related stenosis.

The review emphasizes the limited short-term effectiveness of epidural steroid injections for certain types of chronic back pain. The authors also highlighted the absence of studies investigating the impact of repeated injections or the effects on daily living and work reintegration, suggesting these areas require further research.