Are Epidural Steroid Injections (ESIs) just a Band-Aid? Do they just cover the pain and bring a week or two of relief?

I'm often asked these questions when discussing an Epidural Steroid Injection as a form of treatment with a patient.

My answer has always been no.

In the purest sense I do not believe that a properly prescribed and administered ESI is purely for a quick pain fix. It is true that we are looking to lessen the symptoms of pain---which is likely why the patient presents to our clinic; however, our overall goal is to get the patient back to full functioning status. The first Epidural Medication Injection was performed in 1901, cocaine was injected to treat low back pain. The first recorded corticosteroid usage (ESI) to treat low back pain was in 1952 (Information about these 2 procedures was derived from Medscape: Epidural Steroid Injections). So, 64 years later we are still using ESIs---historically that would lend some credence to their efficacy. ESIs can provide both diagnostic and therapeutic benefits. From a diagnostic standpoint, they can help determine the affected level (or true pain generator). This comes into play when someone has multifactorial disease at multiple levels---sometimes the MRI does not point to any clear issue. Sometimes a spine surgeon will order an ESI to help determine what level they will operate at. The therapeutic benefit is the pain relief provided which, ideally, allows the patient to get their body moving again. In purest form, the ESI is only as good as the clinician who prescribed it and the injectionist who administered it---in this case quality is very important---choose your provider well. But, to be truly fair one needs to include the patient's spinal pathology---how extensive is it, and their motivation to embrace a proper rehabilitation program. ESIs are best used in conjunction with a good exercise program to provide long-term pain relief.

So back to the initial question, are ESIs a Band-Aid?

As addressed above there are several factors that go into the final outcome. However, history has demonstrated in our practice with proper administration of an ESI, we can often calm down the pain symptoms and then establish a good rehabilitation program, so that most patients move forward to function well and have the ability to complete their daily tasks with no significant issue. No, ESIs are not just a Band-Aid, when needed they are a critical component to the overall treatment of a patient with back pain.