Epidural steroid injections (ESIs) have long been a common treatment for back pain, but their effectiveness is now under scrutiny. An updated review by the American Academy of Neurology (AAN), published online on February 12 in the journal Neurology, suggests that ESIs offer limited benefits in reducing back pain and disability. The review analyzed 90 randomized controlled trials conducted between 2005 and 2021, focusing on both short-term (up to three months) and long-term (six months or more) outcomes.
The findings indicate that ESIs may provide a modest reduction in pain for up to three months and possibly reduce disability for six months or longer. However, the data reveal no significant impact on surgical rates when comparing ESI recipients with those who did not receive the treatment. This raises questions about the long-term value of ESIs, especially as a viable solution for chronic back pain management.
"ESIs may be effective as a short-term bridge for acute radicular pain, particularly in those with clear inflammatory markers and no signs of central sensitization, allowing patients to participate in rehabilitation and return to daily activities." – Shaheen Lakhan, MD
For conditions like cervical and lumbar radiculopathies, ESIs "probably possibly" decrease long-term disability, but conclusive evidence is lacking regarding their effect on long-term pain reduction. Similarly, for lumbar spinal stenosis, ESIs might reduce both short-term and long-term disability, yet their efficacy remains uncertain due to insufficient evidence.
"Reinforces what many in pain management have observed — ESIs offer limited long-term benefit and come with significant financial burden." – Shaheen Lakhan, MD
The review underscores the need for a paradigm shift in pain management, advocating for data-driven and personalized care. Precision-guided ESI use that incorporates biomarkers and patient-specific factors might help reduce unnecessary interventions. Dr. Shaheen Lakhan emphasizes the importance of refining patient selection using multi-modal biomarker data, including genomics, imaging, biochemical markers, and functional assessments to predict individuals most likely to benefit from ESIs.
"Rather than a one-size-fits-all approach, we should refine patient selection using multi-modal biomarker data — including genomics, imaging, biochemical markers, and functional assessments — to predict who is most likely to benefit." – Shaheen Lakhan, MD
The review calls for a focus on sustainable and cost-effective strategies that prevent chronic pain rather than merely suppressing symptoms temporarily. This approach aims to transition from the current treatment model to one where interventions are precisely tailored to each patient's needs.
"The future of pain management should focus on data-driven, personalized care, prioritizing sustainable, cost-effective strategies that prevent chronic pain rather than merely suppressing symptoms temporarily." – Shaheen Lakhan, MD
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