Corticosteroids for Pain of Spinal Origin

Targeted interventional delivery of corticosteroids remains a mainstay of treatment for spinal pain syndromes because this approach has a wider therapeutic index than other approaches. The best evidence for analgesic efficacy is in subacute radicular syndromes associated with new-onset or recurrent lumbar radiculitis. Complications often relate to drug delivery technique as much as actions of the steroid itself and require careful consideration and vigilance by the administering physician. Considerable uncertainty persists concerning which patients with chronic pain are most likely to benefit from corticosteroid injections. Matching this treatment option with specific spinal pain syndromes remains a major challenge.

Key points

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Epidural steroid injection (ESI) is the most commonly performed outpatient procedure for the treatment of spinal pain worldwide.
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The epidural approach is most often used to optimize the local, anti-inflammatory effects of corticosteroid at the nerve root level in lumbar radiculitis and neurogenic claudication.
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Facet and sacroiliac joint injection of corticosteroid is widely practiced in pain management to target putative peripheral sources of referred, nociceptive chronic low back pain.
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There are a range of widely used corticosteroid formulations with distinct physicochemical properties that may affect outcomes and side effects profiles.
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ESIs offer the advantage of a more localized corticosteroid delivery to the putative anatomic correlate of pain such as the nerve root, thereby decreasing the likelihood of systemic side effects.