Chronic lower back pain is one of the most common and debilitating conditions worldwide, affecting millions of people and limiting their ability to perform daily activities. In search of relief, many patients turn to treatments such as epidural steroid injections. However, a recent guideline from the American Academy of Neurology (AAN) suggests that the evidence supporting their effectiveness is limited, particularly for certain types of chronic lower back pain.

What Are Epidural Steroid Injections?

Epidural steroid injections are a medical procedure in which a corticosteroid medication is administered into the epidural space of the spine. This treatment aims to reduce inflammation and relieve pain in patients with conditions such as radiculopathy (pain caused by a pinched nerve) or spinal stenosis (compression of the spinal cord or nerves).

Although this procedure has been used for decades, its long-term effectiveness has been debated. A recent systematic review published on February 12, 2025, in the journal Neurology sheds new light on this topic.

Key Findings of the Study

The study, led by Dr. Carmel Armon from Loma Linda University in California, analyzed 90 studies conducted over 16 years that evaluated the use of epidural steroid injections in patients with chronic lower back pain. The researchers focused on two main conditions:

a) Lumbar Radiculopathy:

• The injections provided a modest reduction in pain and disability.
• Compared to patients who did not receive injections, 24% more reported less pain, and 16% more experienced reduced disability for up to three months.
• 11% more patients reported reduced disability for six months or longer.

b) Lumbar Spinal Stenosis:

• The injections appeared to reduce disability but not pain.
• 26% more patients reported reduced disability for up to three months, and 12% more did so for six months or longer.
• No significant reduction in short-term pain was observed.

However, the researchers noted that there was insufficient evidence to assess the effectiveness of these injections for neck conditions such as cervical radiculopathy or cervical spinal stenosis.

Limitations and Concerns

While the results suggest that epidural steroid injections may offer some short-term benefits, the researchers highlighted several limitations:

• Long-term effectiveness: No studies were found evaluating whether repeated treatments are effective.
• Impact on daily life: It was not analyzed how these injections affect patients’ ability to return to work or perform daily activities.
• Lack of research in other areas: There is insufficient evidence regarding their use in treating cervical conditions.

Dr. Pushpa Narayanaswami, co-author of the study and a member of Beth Israel Deaconess Medical Center in Boston, emphasized the need for further research:

“Our review confirms the limited short-term effectiveness of epidural steroid injections for certain forms of chronic back pain. Future studies should address these gaps.”

This is a simple headline

The AAN review confirms that epidural steroid injections can be a moderately effective treatment option for some patients with chronic lower back pain, particularly in cases of radiculopathy and spinal stenosis. However, their effectiveness is limited and not without risks.

Researchers urge the medical community to conduct more studies to assess the long-term effects of these injections and their impact on patients’ quality of life. In the meantime, patients should work with their doctors to develop a personalized treatment plan that addresses their specific needs.