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.


Deepen Your Body of Knowledge

Sci­at­i­ca — Part I



About Ronald Lavine, D.C.

Dr. Lavine has more than thirty five 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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