The Understanding and Appropriate Use of Corticosteroid in Epidural Injection: A Narrative Review

The Understanding and Appropriate Use of Corticosteroid in Epidural Injection: A Narrative Review

Epidural steroid injection (ESI) is one of most popularly used conservative treatments for spinal pain. But concern or fear for adverse effects associated with steroid frequently prevents the patients from being treated by injection, consequently leading them to chronic pain condition or unnecessary extensive treatment. Thus, understanding of not only innate characteristics of steroids but also their utilizations in practice is necessary to decide appropriate method of epidural injection. This article is to review properties of steroids and therapeutic strategies of epidural steroid injection such as dose, repetition, or intervals on the basis of literatures that have been published. Non-particulate steroid is preferred to particulate because of their advantage for prevention of systemic and local adverse effects as well as of their non-inferior clinical efficacy to particulate. High dose, short interval between injections, and large number of injections may be regarded to increase steroid accumulation and consequently risk of systemic side effects. Although conclusive evidence or guideline does not exist, no more than 3 injections within 6 months, maximum 6 injections per year, three weeks interval between injections, especially in case of using particulate steroid are recommended. High dose of steroid is not recommended because no evidence is found that high dose has the ability to promote better outcomes in comparison with low dose. When only partial response is obtained by first injection, repeat injections at appropriate intervals are required to fulfill more complete and prolonged clinical effects by accumulating treatment effects without concerns of overtreatment or abuse.

Epidural steroid injection (ESI) is one of most popularly used conservative treatments for spinal pain. But concern or fear for adverse effects associated with steroid frequently prevents the patients from being treated by injection, consequently leading them to chronic pain condition or unnecessary extensive treatment. Thus, understanding of not only innate characteristics of steroids but also their utilizations in practice is necessary to decide appropriate method of epidural injection. This article is to review properties of steroids and therapeutic strategies of epidural steroid injection such as dose, repetition, or intervals on the basis of literatures that have been published. Non-particulate steroid is preferred to particulate because of their advantage for prevention of systemic and local adverse effects as well as of their non-inferior clinical efficacy to particulate. High dose, short interval between injections, and large number of injections may be regarded to increase steroid accumulation and consequently risk of systemic side effects. Although conclusive evidence or guideline does not exist, no more than 3 injections within 6 months, maximum 6 injections per year, three weeks interval between injections, especially in case of using particulate steroid are recommended. High dose of steroid is not recommended because no evidence is found that high dose has the ability to promote better outcomes in comparison with low dose. When only partial response is obtained by first injection, repeat injections at appropriate intervals are required to fulfill more complete and prolonged clinical effects by accumulating treatment effects without concerns of overtreatment or abuse.