Epidural Injections for Back Pain and Sciatica

If you have back problems or sciatica and your pain is bad enough and has lasted too long, your medical doctor might recommend injecting steroids around the spinal nerve roots. This procedure is known as an epidural injection.

Sometimes epidural injections work effectively. But there are a number of problems with the procedure.

To begin with, it’s not always easy to determine the best spot to inject. That’s because the low back is complicated – the site of maximal degeneration that shows up on an MRI isn’t always the main factor contributing to pain.

Some patients have a negative response to the injections, too. In some cases, the extra volume of fluid injected through the needle is enough to cause more nerve pressure and trigger more pain.

More serious side effects can also occur, including an allergic reaction to the chemicals in the shot.

Epidural Injections Are Effective At Times

But even if the injection successfully alleviates pain, there are limitations.

For one, steroids invariably leave the connective tissues around the joint in worse shape than they were to begin with. They also weaken your bones and contribute to osteoporosis. For these reasons, doctors typically recommend a maximum of three injections or so in a six month period.

Furthermore, steroids usually work only for sciatic pain shooting down the leg, not pain in the low back.

And, unfortunately, the relief is typically temporary, lasting six months or so at best. Of course, for some people whose problems are truly horrendous, even temporary relief is welcome.

Here’s a quote from a journal article published in the Annals of Internal Medicine summarizing the authors’ conclusions about epidural injections:

The available evidence suggests that epidural corticosteroid injections offer only short-term relief of leg pain and disability for patients with sciatica. The small size of the treatment effects, however, raises questions about the clinical utility of this procedure in the target population.

Unfortunately, Medicare outlays for epidural injections have risen nearly seven-fold over the last decade. As is typical with many higher-tech procedures that have become routine parts of modern medical practice, we’re spending more and more public money without necessarily reaping the benefits.

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Deepen Your Body of Knowledge

Sciatica – Part I

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods. His website, askdrlavine.com, provides more information about his approach. Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.
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