A Comprehensive Review of Epidural Steroid Injections for Chronic Back Pain

Insights from the AAN Systematic Review on Epidural Steroid Injections

The American Academy of Neurology (AAN) has recently conducted a thorough review aimed at assessing the effectiveness of epidural steroid injections (ESIs) in alleviating chronic back pain. This comprehensive study, published in the February 2025 online edition of Neurology, updates the AAN's previous evaluation from 2007 and serves as a crucial resource for neurologists and healthcare providers treating patients suffering from persistent back pain.

Understanding Epidural Steroid Injections

Epidural steroid injections involve administering steroid medications into the epidural space surrounding the spinal cord. The primary objective is to decrease inflammation and provide relief for patients experiencing varying forms of chronic back pain. Given the significant impact chronic pain can have on individuals' daily lives—from hindering mobility to affecting sleep—determining the efficacy of such treatments is of utmost importance.

Key Findings of the Review

Dr. Carmel Armon from Loma Linda University School of Medicine points out that chronic back pain is a prevalent issue that detrimental influences the quality of life for many. The systematic review encompasses 90 studies conducted over the last 16 years, focusing on specific conditions such as radiculopathy—a pinched nerve in the spine—and spinal stenosis, where the spinal cord is compressed due to reduced space.

For those suffering from radiculopathy, the review suggests that epidural steroid injections can lead to a modest reduction in pain and disability. Notably, around 24% more patients receiving ESIs reported decreased pain, while 16% noted less disability for up to three months post-treatment. Additionally, some reported reductions in disability lasting up to six months or longer.

In contrast, the findings for spinal stenosis patients are somewhat different. While the treatment may help reduce disability for up to six months, it did not show significant pain relief during the same timeframe. Specifically, a 26% increase in reported reduced disability among treated patients was noted versus those who did not receive the injections, demonstrating the selective efficacy of the procedure.

Limitations and Future Directions

Despite these insights, authors Dr. Pushpa Narayanaswami emphasized the limitations of ESIs, particularly their short-term effectiveness for chronic back pain. Furthermore, the review did not evaluate the long-term outcomes of repeated treatments, nor the broader impacts on patients' daily lives and their ability to return to work.

There remains an evident need for further research to bridge these gaps and determine the most effective approaches to managing chronic back pain. Continuous developments in this field are essential for enhancing treatment protocols and improving patient experiences.

Conclusion

The AAN's recent systematic review represents a significant contribution to the understanding of epidural steroid injections for chronic back pain management. Amidst the evidence presented, healthcare specialists are encouraged to consider both the potential benefits and limitations of this treatment modality. As we advance in neurological medicine, it is critical to ensure that patients receive comprehensive care tailored to their specific needs.

For additional information about brain health, the AAN provides a variety of resources, including a magazine, podcast, and educational materials aimed at fostering awareness among patients and caregivers. Stay connected with the AAN on social media platforms to receive updates on their latest research and findings related to brain health.