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Management of Chronic Low Back Pain with Epidural Steroid Injections

The authors of the study reviewed available studies to determine the efficacy of spinal injections in the management of chronic low back pain (CLBP). Spinal injections are also used in the diagnosis of CLBP. While conventional medicine suggests that 75-90 percent of low back pain is non-specific, studies using flouroscopic guided diagnostic procedures may better identify various sources of low back pain. The results of the studies suggest that 67-75 percent of low back pain cases can be accurately diagnosed. In fact, among the studies, 30-50 percent of low back pain was determined to be caused by internal disc disruption, 13-19 percent the result of sacroiliac joint dysfunction, and 15-17 percent due to facet joint pain.

The three spinal injections evaluated for efficacy in the management of CLBP were caudal epidural steroid injection (CESI); interlaminar epidural steroid injection (ILESI); and transforaminal epidural steroid injection (TFESI). The medications typically administered are a corticosteroid and local anesthetic which provide potent anti-inflammatory properties as well as neural stabilizing effects.

When evaluating available studies, the authors felt that critical features to be assessed were the route of injection, number of injections, clinical presentation, diagnostic evaluation, length of follow-up, and outcome measures.

The authors of the study concluded that there is evidence to suggest that non-target specific ESIs are effective for short-term improvement in nonspecific CLBP. There is not enough data to suggest that there are Long-term benefits of spinal injections in the management of CLBP. The authors note that there is a lack of randomized controlled studies with the above criteria to evaluate efficacy of specific spinal injections in the management of CLBP. The authors do suggest however, that TFESIs are likely most appropriate in targeting discogenic pain when confirmed that the disc is the source of the CLBP.

References: M.J. DePalma, C.W. Slipman. Evidence informed management of chronic low back pain with epidural steroid injections. The Spine Journal. January/February 2008. Volume 8. Issue 1. Pp. 45-55.

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