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  • Epidural Steroid...

Epidural Steroid Injections for Back Pain Treatment offer mixed results: AAN

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-03-16T20:30:08+05:30  |  Updated On 17 March 2025 10:32 AM IST
Epidural Steroid Injections for Back Pain Treatment offer mixed results: AAN
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A review by the American Academy of Neurology (AAN) has found that epidural steroid injections (ESIs) provided short-term relief for patients with radiculopathy. However, their effectiveness in other cases was unclear or limited, with minimal impact on reducing overall back pain and disability. The recent study was conducted by Carmel A. and fellow researchers.

ESIs are commonly used for managing pain and disability associated with cervical and lumbar spinal stenosis and radiculopathies. While ESIs have been widely adopted, their long-term effectiveness remains uncertain. This systematic review evaluated evidence from 90 RCTs conducted between January 2005 and January 2021, aiming to clarify the extent of pain relief and functional improvement achieved through ESIs.

The researchers conducted a search of multiple databases for RCTs evaluating the effectiveness of ESIs in cervical and lumbar spinal stenosis and radiculopathies. Because of the large variability in outcome measures across studies, SRD was used to synthesize data standardized for analysis. NNT was also computed for clinical interpretation. The outcomes of short-term and long-term pain and disability measurements were evaluated to determine the efficacy of ESIs.

Key Findings

• In cervical and lumbar radiculopathies, ESIs probably reduce short-term pain (SRD -24.0%, 95% CI −34.9 to −12.6, NNT 4) and short-term disability (SRD −16.0%, 95% CI −26.6 to −5, NNT 6).

• ESIs possibly reduce long-term disability in radiculopathies (SRD −11.1%, 95% CI −25.3 to 3.6, NNT 9).

• There is insufficient evidence to confirm that ESIs reduce long-term pain in radiculopathies (SRD −10.3%, 95% CI −27.8 to 7.6).

• In lumbar spinal stenosis, ESIs possibly reduce short-term disability (SRD −26.2%, 95% CI −52.4 to 3.6, NNT 4) and long-term disability (SRD −11.8%, 95% CI −26.9 to 3.8, NNT 8).

• However, ESIs do not significantly reduce short-term pain in lumbar stenosis (SRD −3.5%, 95% CI −12.6 to 5.6).

• There is insufficient evidence to determine whether ESIs reduce long-term pain in lumbar stenosis (SRD −6.5%, 95% CI −22.5 to 9.8).

• In cervical spinal stenosis, evidence is insufficient to determine the effectiveness of ESIs for either pain or disability.

The study authors concluded that ESIs provide only limited benefits in managing pain and disability in cervical and lumbar radiculopathies, with some possible effectiveness in lumbar spinal stenosis, particularly in the short term. Given the variability in outcome measures, further high-quality research is needed to establish the true clinical effectiveness of ESIs.

Reference:

Armon, C., Narayanaswami, P., Potrebic, S., Gronseth, G., Bačkonja, M.-M., Cai, V. L., Dorman, J., Gilligan, C., Heller, S. A., Silsbee, H. M., & Smith, D. B. (2025). Epidural steroids for cervical and lumbar radicular pain and spinal stenosis systematic review summary: Report of the AAN guidelines subcommittee. Neurology, 104(5).https://doi.org/10.1212/wnl.0000000000213361

American Academy of NeurologyEpidural steroid injectionsspinal stenosisradiculopathypain managementdisabilitylumbar spinecervical spinesystematic review
Source : American Academy of Neurology
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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