The Argument for Use of Epidural Steroid Injections in Management of Acute Radicular Pain

By James P Rathmell, MD

Fall 2007 - Volume 11 Number 4


Low back pain is the fifth most common problem that leads patients to seek medical attention, comprising 2.8% of physician office visits in an analysis of the National Ambulatory Medical Care Survey data.1 The only more frequent problems were hypertension (5.5%), pregnancy care and complications (5.2%), general medical exams and well care (4.1%), and acute upper respiratory infections (3.3%). The majority of episodes of acute low back pain with or without radicular pain will resolve without specific treatment. Overall, 60% to 70% of those affected recover by six weeks and 80% to 90% recover by 12 weeks.2 Epidural injection of steroids has been used to treat low back pain for many decades and now is in widespread use in many countries. There have been numerous randomized trials examining the efficacy of this approach. The rationale behind injecting glucocorticoid into the epidural space adjacent to the spinal nerve is that it will combat the inflammatory response associated with acute disc herniation and thus reduce pain.3,4 This inflammation can lead to direct neuronal activity, as well as swelling and mechanical compression of the nerve within the intervertebral foramen.

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