Summary: Epidural steroid injection is one of the effective ways of providing pain relief and back pain management in those living with chronic low back pain. If a person responds to the injection and reports some benefit, doctors may repeat the injection multiple times in a year. However, the frequency of epidural steroid injections would depend on many factors like a response to the first injection and the kind of corticosteroid the doctor uses, and a doctor would also need to consider adverse effects like HPA suppression.
Steroids are potent anti-inflammatory drugs, and can be called as the best thing for back pain solutions as they help relieve chronic pain. Not only that, these injections may provide prolonged relief in many cases. In addition, an epidural steroid injection is a non-surgical treatment of low back pain caused by various ailments, including disc herniation. In rare cases, doctors may even use it for neck pain.
It is a procedure that uses commonly available corticosteroids. Nonetheless, injecting these drugs into the epidural space requires much expertise, as any mistake can cause many complications, like nerve injury, epidural hematoma, and more. When it comes to the frequency of epidural shots to be used for back pain, there are different viewpoints. Some say that one can frequently repeat these injections and that the time between the two injections is not relevant. On the other hand, there are recommendations not to use more than 4 to 6 injections in a year. However, researchers warn that both of these are myths.
How often one can be injected with epidural steroids depends on many factors. For example, if the first epidural injection did not provide any relief, chances are slim that another injection would do any good. It means that repeated injections can only be considered in those who have responded to the first injection, even if they reported just a minor relief.
When it comes to the frequency, first and foremost, it is vital to understand that injection cannot be repeated for a period of up to two weeks. This period is essential to assess the clinical response. After all, corticosteroids are not painkillers or anesthetics; they need a longer time to start working.
However, there is another issue to consider. Corticosteroids affect the hypothalamic–pituitary–adrenal (HPA) axis, and this influence may last for three weeks or longer. Unfortunately, this causes some side effects like hyperglycemia, increased blood pressure, and more. Fortunately, the effects related to HPA do not last for long, and most effects are gone within 48-72 hours, though mild effects may remain for a long.
Then there are studies that show the essentiality of repeating epidural steroid injection at the earliest in those who responded to the first injection. In such cases, early repetition of the second injection may provide greater and prolonged relief. Thus, the frequency of epidural injection is something that the treating doctor must decide. Flat recommendations like 4 to 6 injections in a year do not work.
Thus, when it comes to the frequency of epidural steroid injection, it would vary from patient to patient. The biggest deciding factor here is a response to the treatment. If the first injection did not help, then the second or third injections are not likely to help. However, if epidural steroids did help, doctors would still need a couple of weeks to assess their efficacy. They would also need two- or three-week intervals to prevent side effects from such injections related to the suppression of HPA.
Further, experts note that frequency also depends on the kind of steroid used for epidural injection. For example, the effect of some steroids is long-lasting, though they are also more likely to cause side effects. On the other hand, short-acting steroids would help for a shorter time, but they have a better safety profile. To sum up, there are many factors that decide the frequency of epidural steroid injection, and any such decision is best taken by the treating doctor.
As far as patients are concerned, they must not interfere with such treatment, as there is much conflicting and inaccurate information on the internet. The treating doctor will decide the frequency by keeping in mind the safety and response to the procedure.
By Gurpreet Singh Padda, MD, MBA