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Am Fam Physician. 2022;106(1):89-90

Author disclosure: No relevant financial relationships.

Clinical Question

Are epidural steroid injections effective for low back pain?

Evidence-Based Answer

Treatment with epidural steroid injections in the lower spine is not effective for reducing pain and disability. The injections may be more effective than placebo at short-term follow-up, but the effects are not clinically meaningful. (Strength of Recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs].) Epidural steroid injection has minimal benefit for patients with chronic (12 months or longer) low back pain. (SOR: A, meta-analysis of RCTs.)

Evidence Summary

A 2020 systematic review of 25 RCTs (N = 2,470) compared the effects of epidural steroid injection (including various dosages of betamethasone, dexamethasone, methylprednisolone, prednisolone, prednisone, triamcinolone) using caudal, interlaminar, or transforaminal approaches with placebo (including normal saline or local anesthetic) in patients with lumbosacral radicular pain.1 Patients had mean ages ranging from 37 to 53 years. Primary outcomes included leg pain measured by various assessments such as a visual analog scale or numeric rating scale; disability measured by self-reported Oswestry Disability Index or Roland-Morris Disability Questionnaire; and adverse effects. A clinically important difference was stated to be a mean difference (MD) between groups that was greater than 10% of the scale. The outcomes data were also grouped into points of assessment: immediate term (two weeks or less), short term (more than two weeks but less than three months), intermediate term (more than three months but less than 12 months) and long term (12 months or more). Duration of follow-up ranged from 12 hours to one year.

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Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

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