Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Epidural Corticosteroid Injections for Pain

Assessing benefits and risks for radiculopathy

Publish date:: September 15, 2015

Epidural corticosteroid injections for radiculopathy are associated with short-term improvements in pain and function with no effect on long-term surgery risk. They do not appear to be effective for spinal stenosis. This is based on an analysis of 30 placebo-controlled trials (n=2,912) for epidural corticosteroid injections for radiculopathy, and 8 trials (n=821) for spinal stenosis. Among the conclusions were:

• Epidural corticosteroids were associated with greater immediate-term reduction in pain (-7.55), function (-0.33), and short-term surgery risk (RR=0.62).

• There were no clear effects of epidural corticosteroid injections for spinal stenosis.

• Serious adverse events were rare.

Citation: Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis. Ann Intern Med. 2015;163:373-381. doi:10.7326/M15-0934.

Commentary: Epidural steroids have increased in use with very little data to support their efficacy¹. Multiple reviews and meta-analyses, including this one, have shown that epidural steroid injection may have limited short-term efficacy, and do not affect long-term pain control. While the risks of epidural injections are small, so are the benefits. Additional research into effective non-surgical solutions for radiculopathy and spinal stenosis are sorely needed. —Neil Skolnik, MD

1. Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann In- tern Med. 2012;157:865-77.

This Week's Must Reads

Consider potential cognitive complications prior to androgen deprivation therapy,

Diabetes raises risk of prostate cancer mortality in obese men,

Salivation inhibition fails to reduce radioiodine toxicity in prostate cancer,

Highest positive surgical margin predicts poor survival after prostatectomy,

Young minority men are underinformed about prostate cancer screening,

Must Reads in Pain

Survey: Cancer-Related Pain, Opioid Use Up Since 2018,

Support For Medical Marijuana Transcends Political Affiliation,

Study Confirms Device’s Ability to Lift Anxiety, Depression, Pain ,

Smaller Right Hippocampal Volume Tied to Chronic Pain, Depression,

Sleep Disturbance and Chronic Pain Intensity, Clin J Pain; ePub 2019 Mar 25; Burgess, et al