Neurology® Podcast Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis
Feb 20, 2025
Dr. Carmel Armon, a neurologist at Loma Linda University, discusses the effectiveness of epidural steroid injections in treating cervical and lumbar radicular pain. She emphasizes the contrast between anecdotal evidence and clinical studies, revealing the injections provide limited long-term relief, with modest short-term pain reduction. The conversation highlights the complexities of pain management and the need for further research to clarify treatment outcomes and set realistic patient expectations.
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Importance of Controlled Studies
- Pain treatments perceived as effective, based on uncontrolled observations or case studies, may be ineffective in controlled studies.
- Well-designed studies calculate the number of patients needed to treat to achieve a minimal clinically significant improvement.
Limited Efficacy of ESIs
- Epidural steroid injections (ESIs) may offer modest pain reduction for up to three months and reduce disability for up to six months.
- Most studies focus on lumbar ESIs, so effectiveness for neck pain remains unclear.
Understanding Limited Efficacy
- "Limited efficacy" considers effect size and the magnitude of difference between treatment and control groups.
- Studies rarely measure treatment effects in terms of minimal clinically meaningful difference.