The American Academy of Neurology published an updated systematic review on epidural steroid injections (ESIs), and the findings are something everybody should keep in mind.
So what was this study?
A panel of neurologists and pain specialists wanted to answer two simple questions: do epidural steroids reduce pain and disability for people with radiculopathy, and do they help people with spinal stenosis?
The short version? The shots might help a little, for a little while, in some patients. That’s it.
The numbers you need to know
For radiculopathy (cervical and lumbar):
- ESIs probably reduce short-term pain for some people. About 24% more patients did better with the steroid than without it, which works out to treating 4 patients for one extra person to get any relief.
- ESIs probably reduce short-term disability too for some people, but by less (16% difference, NNT of 6).
- For long-term disability, it’s a “possibly” for some people, and the confidence interval crosses zero, meaning it could be no effect at all.
- For long-term pain? Insufficient evidence. Nobody can say whether the shots help past 6 months.
For lumbar spinal stenosis:
- ESIs probably do not reduce short-term pain. The difference was just 3.5%, basically noise.
- They possibly help short-term and long-term disability, but again with low confidence.
- Long-term pain? Insufficient evidence.
For cervical spinal stenosis: Zero qualifying studies. None.
And a few more that jumped out:
- Reported complication rates range from 2.4% to 16.8%. Most are minor (increased pain, injection site pain, numbness), but serious events are documented, and the FDA has required a warning on epidural steroids since 2014 about rare but serious neurological events like stroke, paralysis, and vision loss.
- The review found NO evidence that ESIs improve daily function, quality of life, return to work, or opioid use.
Here’s the key part.
The authors point out that in the UK, NICE guidance uses ESIs as a short-term tool to reduce pain so patients can get moving and start other treatments, not as a long-term pain management plan. They even call for research into why the US keeps using them for chronic pain.
Read that again. The best-case role for the shot, according to the neurologists themselves, is buying a window so the patient can get into active, conservative care; like Chiropractic.
That’s what I do every day.
So the next time a patient asks, “Should I get the shot?”, you can tell them honestly: the best research shows it may take the edge off for a few weeks, it doesn’t appear to change long-term pain or the need for surgery, and whatever they decide, the real work of getting them moving and functioning again happens with active conservative care. That’s not bashing anyone. That’s evidence-based co-management, and it positions you exactly where you belong: as the provider focused on lasting function.
Dr Edwin J Travis, DC, CCSP, CVCP, ACN has been in active practice for 42 years with excellent success with these types of problems. Consultation appointments at 512-321-4481. http://www.TravisChiropracticCenter.com