Epidural Steroid Injections for Neck Pain

TREATMENT FOR NECK PAIN

Ice and Heat for Neck Pain

Manipulation for Neck Pain

Acupuncture for Neck Pain

Epidural Steroid Injections for Neck Pain

NSAIDs for Neck Pain

TENS for Neck Pain

Laser for Neck Pain

 

Treatment Ratings

R E S C U R

RISK: 1/5

1_Heart_Rating

The FDA has recently issued a warning notice regarding ESI’s, noting:

  • Rare but serious problems have occurred after injection of corticosteroids into the epidural space of the spine to treat neck and back pain, and radiating pain in the arms and legs.
  • These serious problems include loss of vision, stroke, paralysis, and death.
  • The effectiveness and safety of injection of corticosteroids into the epidural space of the spine have not been established, and FDA has not approved corticosteroids for this use.
  • Discuss the benefits and risks of epidural corticosteroid injections with your health care professional, along with the benefits and risks associated with other possible treatments.
  • https://www.fda.gov/Drugs/DrugSafety/ucm394280.htm

The FDA’s Anesthetic and Analgesic Drug Products Advisory Committee concluded that ESIs should not be recommended in the cervical region.

https://www.fda.gov/Drugs/DrugSafety/SafeUseInitiative/ucm434387.htm#esi

E

EFFECTIVENESS: 2/5

2_Hearts_Treatment_Rating

The research on ESI’s is considered inconclusive at this point, because it is felt more studies are needed to make more definite conclusions and recommendations. The research is complicated by the fact that there are multiple factors to consider. Here are just a few:

  • Was numbing medicine used alone or in combination with a steroid?
  • What exactly was the cause of the problem (disc herniation, stenosis, arthritis?)
  • Was the procedure performed by a very experienced provider?
  • Was the procedure performed under fluoroscopy (motion xray), allowing the doctor to see more precisely where the medicine was being injected?

One recent study compared patients who received medication and physical therapy, ESI alone, or a combination of all treatments, and found all three approaches helped similarly but combination therapy helped most.

Cohen SP et al, Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain A Multicenter, Randomized, Comparative-effectiveness Study. Anesthesiology 2014; 121:1045-55

While some studies have shown short-term benefit, and even benefits lasting up to one year, no studies indicate ESI’s are a long-term solution for cervical radiculopathy (pinched nerves.)

Peloso P, Gross A, Haines T, Trinh K, Goldsmith CH, Aker P; Cervical Overview Group. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000319.

Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical  epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994 Aug;58(2):239-43.

The American Academy of Neurology reviewed the current scientific evidence and concluded ESI’s have no long-term impact on function, the likelihood of having surgery or pain relief beyond 3 months, and therefore do not recommend ESI’s.

The FDA’s Anesthetic and Analgesic Drug Products Advisory Committee concluded that ESIs should not be recommended in the cervical region.

https://www.fda.gov/Drugs/DrugSafety/SafeUseInitiative/ucm434387.htm#esi

Despite the fact that ESI’s are widely used, the scientific literature has not shown them to be effective, and they have never been approved for this use by the Food and Drug Administration (FDA.)

S

SELF CARE: 0/5

0_Hearts_Treatment_Rating

ESI’s can only be performed by specially trained physicians, such as anesthesiologists, pain management specialists, neurosurgeons and physical medicine and rehab specialists.

C

COST: 3/5

3_Hearts_Treatment_Rating

Prices can vary depending on geographic location and other factors, but typically range from $600 to $2000 per injection.

U

USEFULNESS (overall rating): 1/5

1_Heart_Rating

Epidural Steroid Injections (ESIs) should be considered when more conservative measures have failed, although the research shows they are not more effective than other measures, don’t reduce the likelihood of surgery, and are expensive. However, recent reports have pointed out the significant risk of severe injury, stroke and even death. For that reason we can only give ESI’s one heart, because there may be circumstances where an ESI is the right choice for you, after a thorough discussion with your doctor.

These injections of steroid are used to reduce inflammation and flush inflammatory chemicals into the area where the nerves leave the spinal cord. They are used for patients with cervical disc herniations, or for patients with stenosis(narrowing of the bones around the nerve) or bony growths due to arthritis. These conditions can cause pressure or irritation of the nerves leaving the spinal cord and can produce radiating pain into the arms or upper back, commonly referred to as a “pinched nerve.”

Epidural steroid injections (ESI) are widely used for “radicular” or radiating pain, where nerve roots are affected causing pain, typically into the arm or upper back.. They are usually tried when more conservative methods fail.

The injection usually consists of an anesthetics or numbing medicine, combined with a steroid. There are different ways the medication is injected into the spinal region (intralaminar, transforaminal and caudal approaches) with varying degrees of effectiveness and risks for each. In addition, the procedure can be done with and without fluoroscopy (motion xrays) which can also affect safety and how well it works.

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