My sister has had three steroid injections into her spine. She hasn’t gotten any pain relief. We tell her enough is enough. She should quit getting this treatment. Should she have another one?

The use of epidural steroid injections (ESI) has increased despite a lack of evidence to support it. Doctors and patients turn to its use when conservative (nonoperative) care has been tried and failed. They like it because it seems like a safe (and less expensive) alternative to surgery or opioid use.

But studies on the use of ESI report a wide range of success. Success rates vary from 18 per cent up to 90 per cent with ESI use. And it’s not clear yet how many, how often, and in which patients ESI should be used.

Some surgeons use ESI to pinpoint the exact cause of the problem. If they can find the pain generator, then surgery to deal with the problem can be more precise and accurate. In a recent VA study, the use of ESI did not reduce the number of patients receivingopioids (narcotic drugs). And it wasn’t always a substitute for lumbar surgery.

Before having a fourth ESI, your sister may want to explore other options. A multimodal approach to chronic pan is often suggested. This type of treatment combines many different treatments until optimal pain relief or control is obtained.