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.