For many people, back pain goes away on its own or with nonsurgical treatments. Epidural steroid injections shouldn't typically be used as a first-line therapy for back pain relief, but that doesn't mean they can't play a role in treating pain. But injections won't cure the underlying cause of back pain, and they provide only temporary relief. Unfortunately, in many cases, chronic back pain can't be cured, but must instead be managed, like other chronic conditionsand patients must have realistic expectations of what epidurals can do.
Corticosteroids are used to control inflammation in arthritis and other inflammatory conditions. Corticosteroids can be injected directly into inflamed tissues, or they can be delivered to the whole body via oral preparations, intravenous injections, or intramuscular injections. Steroid injections may provide significant relief to patients with arthritis or musculoskeletal conditions. For patients with rheumatoid arthritis , the injections are typically offered when only one or two joints display active synovitis . The goal of treatment is to quell symptoms of a flare or to enable slower-acting drugs, such as methotrexate or Plaquenil , time to work. For example, in early rheumatoid arthritis, study results revealed that a combination of DMARDs and intra-articular steroids is significantly better than DMARDs alone.
Radiculopathy occurs when something irritates a spinal nerve—say a “slipped disc” causing a pinched nerve. This is also called sciatica . There are resident stem and other cells in the local tissues everywhere in our body. Many live around blood vessels. These are obviously also present in the disc and nerves in the epidural space and they usually play an important role in suppressing inflammation and repairing damage. We know, based on a copious in vitro (lab) data, that the high-dose steroids used in epidural injections can kill these cells. So the progression of the series of epidural steroid injections looks a little something like this: