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Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

From the Division of Neurology (C.A.), Baystate Medical Center, Springfield, and Tufts University School of Medicine, Boston, MA; Manhasset, NY (C.E.A.); Pompano Beach, FL (J.S.); and University of Wisconsin Madison (M.-M.B.).

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116; e-mail: guidelines{at}aan.com

Based on the available evidence, the Therapeutics and Technology Assessment subcommittee concluded that 1) epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments (Level C, Class I-III evidence). The average magnitude of effect is small and generalizability of the observation is limited by the small number of studies, highly selected patient populations, few techniques and doses, and variable comparison treatments; 2) in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended (Level B, Class I-III evidence); 3) there is insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain (Level U).

See the conflict of interest statement at the end of the text.

Received July 6, 2006. Accepted in final form December 1, 2006.

Approved by the Therapeutics and Technology Assessment Subcommittee on July 28, 2006; by the Practice Committee on November 11, 2006; and by the AAN Board of Directors on December 7, 2006.

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