Epidural steroid injections for radicular lumbosacral pain: a systematic review

• Published in: Physical medicine and rehabilitation clinics of North America Vol. 25; no. 2; p. 471
• Main Authors: Shamliyan, Tatyana A, Staal, J Bart, Goldmann, David, Sands-Lincoln, Megan
• Format: Journal Article
• Language: English
• Published: United States 01.05.2014
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adult; Aged; Disability Evaluation; Dose-Response Relationship, Drug; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Incidence; Injections, Epidural; Low Back Pain - diagnosis; Low Back Pain - drug therapy; Low Back Pain - epidemiology; Lumbosacral Region; Male; Middle Aged; Pain Management - methods; Pain Measurement; Radiculopathy - diagnosis; Radiculopathy - drug therapy; Radiculopathy - epidemiology; Risk Assessment; Severity of Illness Index; Treatment Outcome; United States - epidemiology; United States; Lumbosacral radicular syndrome; Epidural injection; Low back pain; Steroids
• ISSN: 1558-1381
• DOI: 10.1016/j.pmr.2014.02.001

Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain.