Research: The Dark Secret of Epidural Steroid Injections

Wednesday, April 6th, 2016
Doctor holding Injection

We see people literally every week that are considering undergoing epidural steroid injections. People consider this procedure for several reasons. The most common reasons are conditions such as musculoskeletal pain (especially in the low back and neck), nerve pain or radiculopathy, and/or spinal stenosis.

We try to stress to these patients that there is solid research showing that these injections are only good for short-term use and only in a certain percentage of people that they are given to. And, even when they do work, they usually have to be repeated since they commonly do not last very long. This makes sense when you think about it because the injections are only treating the inflammation caused by the irritated disc. The injections are not treating the disc itself.

Essentially, you are taking the battery out of the smoke alarm….but the fire is still going.

The national pain report tells us that nearly 9,000,000 spinal injections are performed annually in the United States.

Some of the side effects and drawbacks of the epidural steroid injections are as follows:

  • Arachnoiditis, which is an inflammation and infection in the membrane around the spinal cord.
  • Increased risk of spinal fractures due to the bone deterioration. Each successive injection increases the risk of spinal fracture by 21%
  • Nerve damage due to the needle coming into contact with the nerves
  • Bleeding due to an underlying disorder
  • Dural puncture
  • Increased pain rather than decreased pain
  • Headaches
  • Sleeplessness or fever
  • Stomach ulcers
  • Cataracts
  • All of this risk, for a very short-term solution that works for less than 50% of the patients and costs over $2000 per injection. It makes absolutely zero sense outside of an emergency situation.

    With that in mind, let’s get to the research. After you read it, you’re going to wonder why anyone would want to undergo such a procedure, why the treatment continues to rise in popularity, and why they continue to prescribe it. You may also wonder why the medical world continues to chastise chiropractors for treating back pain successfully through natural remedies.

    Why they did it

    It is obvious that the use of epidural steroid injections is on the rise every year. The authors of this paper wanted to review the evidence regarding the pros and cons of epidural steroid injections used in adults that were suffering from low back pain that radiated or in adults that we’re suffering from spinal stenosis.

    How they did it

    • They used common and standard data sources such as Ovid MEDLINE (through May 2015), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, prior systematic reviews, and reference lists.
    • From these databases they selected trials versus placebo interventions or studies comparing epidural injection techniques, corticosteroids, or different doses.

    What they found

    • 30 placebo trials studied the injections used for radiculopathy
    • Eight studies looked at effectiveness for spinal stenosis.
    • When treating radiculopathy, the injections showed greater immediate reduction in pain, function, and short-term surgery risk.
    • The effects were below the predetermined clinically important threshold
    • There were no long-term benefits whatsoever.
    • There injection had ZERO effects for spinal stenosis.

    Wrap it up

    Although the steroid injections for radiculopathy showed some short-term relief in pain and short-term increase in function, the benefits seen in the patients were only small and short-term only. There was no effect long-term and no affect on whether or not the person had surgery eventually. The evidence in this paper suggested there was no effectiveness at all for the treatment of spinal stenosis.

    Chou R, et. al., “Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis”. Ann Intern Med. 2015 Sep 1;163(5):373-81.

    Just another reason to call a chiropractor TODAY!

    Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising your general, overall level of health!

    Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.

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    Till next time……

    The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
    Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo, Canyon, Pampa, Happy, White Deer, Dumas, Groom, Conway, Panhandle, Claude, Clarendon, Borger, Tulia, Hereford, Fritch, Bushland, and Vega communities.

    Visit our main website at for customized Chiropractic in Amarillo TX.

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    by Jeff S. Williams, D.C.
    Chiropractor in Amarillo
    Accident Chiropractic
    Creek Stone Integrated Care