Injectable Medication for Low Back Pain

EFFECTIVENESS: 2/5

Transforamenal Epidural Steroid Injection (TFESI) is recommended to provide relief of radicular pain related to lumbar disc herniation. TFESI has been found to be effective in providing pain relief for at least one month in more than fifty percent of patients, with half of these patients continuing to benefit from treatment for a year or more. Treatment can be repeated in those patients whose pain recurs. (NASS 2013).

The rate of epidural steroid injections and associated costs are climbing rapidly according to studies, although the reasons for this are not completely clear.

A recent review showed a success rate for epidural injections between 18 and 90%, and noted, “ESIs can offer short-term pain reduction to a select group of patients, but there is little evidence of long-term improvement in pain or function.”

Source:

Friedly, J, Standaert C, and Chan L:Phys Med Rehabil Clin N Am. 2010 Nov; 21(4): 659–677.

SELF CARE: 1/5

This procedure is typically performed in a hospital, clinic or ambulatory surgical center. It is considered a surgical procedure, typically done by pain management physicians, anesthesiologists and some other specialists. Many of these providers will use fluoroscopy (motion x-rays) to provide better visualization of exactly where the medication is inserted.

This procedure must be provided by a licensed specialist.

COST: 2/5

Epidural injections are usually covered by insurance but can cost about $3000 per injection. Recent analysis of cost effectiveness suggests there is insufficient evidence on which to judge cost effectiveness.

This can be a fairly expensive procedure depending on where it is done and by whom. Typically, up to three injections are provided, spaced over several months.

Lumbar Transforaminal Epidural Steroid Injections Review & Recommendation Statement January 2013, North American Spine Society.

USEFULNESS (overall rating): 2/5

A number of factors need to be considered in evaluation epidural injections for overall usefulness. It has some substantial risk, and only works about half the time, but careful patient selection may increase those odds. It is pretty expensive. However, for patients with excruciating leg pain associated with lumbar disc herniation, it may provide dramatic and quick relief. It may also reduce the likelihood of the need for surgery right away, although studies suggest it doesn’t reduce the overall likelihood of surgery.

The decision to proceed with epidural injections should be made in concert with your providers, and typically would be tried after more conservative options (rest, medication, manipulation, massage, acupuncture) have been tried and failed.