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February 13, 2025 — The American Academy of Neurology (AAN) has released an updated systematic review on the effectiveness of epidural steroid injections for chronic back pain. Published in Neurology, this review aims to provide neurologists and other healthcare professionals with the latest evidence on whether these injections reduce pain and disability in patients with specific types of chronic back pain. The update builds upon a previous assessment conducted by the AAN in 2007.
Understanding Epidural Steroid Injections
Epidural steroid injections involve injecting a corticosteroid into the epidural space of the spine to alleviate pain. This treatment is often used for conditions such as radiculopathy and spinal stenosis, both of which can cause significant discomfort and impair daily functioning.
“Chronic back pain is common and can negatively impact a person’s quality of life, making it difficult to move, sleep, and participate in daily activities,” said Dr. Carmel Armon of Loma Linda University School of Medicine, a Fellow of the AAN and an author of the review. “Our findings suggest that epidural steroid injections may have limited efficacy. They can modestly reduce pain for some patients for up to three months and reduce disability for up to six months or more.”
Findings from the Review
Researchers analyzed 90 studies over a 16-year period, examining the use of epidural steroid injections for radiculopathy and spinal stenosis.
Effectiveness for Radiculopathy
Radiculopathy is caused by a pinched nerve in the spine. The review found that epidural steroid injections may provide modest relief:
- 24% more patients receiving the injections reported reduced pain compared to those who did not receive the treatment.
- 16% more patients experienced reduced disability for up to three months.
- 11% more patients reported reduced disability for up to six months or more.
- Most studies focused on radiculopathy in the lower back, making it unclear whether the treatment is effective for cases in the neck.
Effectiveness for Spinal Stenosis
Spinal stenosis occurs when the space around the spinal cord narrows, compressing nerves. The review found:
- 26% more patients who received the injections experienced reduced disability for up to three months.
- 12% more patients reported reduced disability for up to six months or longer.
- The treatment did not significantly reduce pain for up to three months.
- Studies only examined patients with stenosis in the lower back, leaving questions about its effectiveness for stenosis in the neck.
Need for Further Research
“Our review affirms the limited effectiveness of epidural steroid injections in the short term for some forms of chronic back pain,” said Dr. Pushpa Narayanaswami of Beth Israel Deaconess Medical Center in Boston, also a Fellow of the AAN. “We found no studies evaluating whether repeated treatments provide additional benefits or how the injections impact daily activities and return to work. Future studies should address these gaps.”
The systematic review highlights the importance of considering other treatment options for chronic back pain and calls for more research on long-term outcomes.
Disclaimer
This article summarizes findings from a systematic review published in Neurology and is intended for informational purposes only. It does not constitute medical advice. Patients should consult their healthcare providers for personalized recommendations regarding chronic back pain treatment.
