March 9, 2007
A guideline developed by the American Academy of Neurology finds epidural steroid injections play a limited role in providing short-term pain relief for lower back pain that radiates down a leg, and do not provide long-term pain relief. The guideline is published in the March 6, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.
To develop the guideline, the authors analyzed scientific studies on the topic.
According to the guideline, epidural steroid injections may provide some short-term pain relief between two and six weeks after injection, but the average amount of relief is small.
"While some pain relief is a positive result in and of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful," said lead author Carmel Armon, MD, MHS, Chief, Division of Neurology, with Baystate Medical Center in Springfield, Massachusetts, and Professor of Neurology at Tufts University School of Medicine in Boston, Massachusetts. Armon is also a Fellow member of the American Academy of Neurology.
The guideline also found epidural steroid injections usually did not help patients "buy time" to avoid surgery, or provide long-term pain relief beyond three months. Their routine use for these purposes is not recommended.
"The use of epidural steroid injections to treat chronic back pain is increasing over time despite limited quality data," said Armon. "Recent figures show 1999 Medicare Part B claims for lumbar epidural steroid injections were $49.9 million, for 40.4 million covered individuals."
In addition, the authors also found insufficient evidence to use epidural steroid injections to treat radicular cervical pain, or neck pain.
Armon says the review was limited by the small number of high-quality scientific studies on epidural steroid injections, and further well-designed studies are needed to determine their effectiveness.