Researchers: Ali Ghahreman, et al.
RESEARCH In response to sports injuries, coaches are historically known to offer advice like, "Shake it out" or "Walk it off." But as anyone with a disc herniation knows, such advice is futile and often harmful. A recent study published in Pain Medicine suggests that the location of the epidural steroid injection is key to providing significant relief from lumbar radicular pain.
Lumbar radicular pain (sciatica) is most commonly caused by lumbar disc herniation and inflammation of the nerve roots. As an alternative to surgery, epidural steroid injection, by either the interlaminar or caudal route, is the most widely used steroid treatment for pain relief. However, studies indicate that interlaminar injections are no more effective than normal saline injections into an interspinous ligament, while caudal epidural injections of steroids have failed to prove superior to local anaesthetic alone. [1,2]
Transforaminal injection—the injection of steroids directly and accurately onto the affected spinal nerve under radiologic guidance—has proved more effective than interlaminar injection of steroids with respect to pain relief and improvement of disability. 
|Transforaminal Steroid Injection||Transforaminal Local Anesthetic||Transforaminal Saline Injection||Intramuscular Steroids||Intramuscular Saline|
|54 %||7 %||19 %||21 %||13 %|
One hundred and fifty patients were studied. Relief of pain was corroborated by clinically significant improvements in function and disability, and reductions in use of other health care. Outcomes were equivalent for patients with acute or chronic radicular pain. Twenty-five percent maintained relief beyond 12 months.
Study leader Dr. Bogduk concludes, "In essence, transforaminal injection of steroids is a viable alternative to surgery for lumbar radicular pain due to disc herniation. Its immediate yield is modest, but substantial, and is not simply a placebo effect. For long-term efficacy, proof beyond reasonable doubt would require prohibitively large studies."
Was this information helpful? Let us know below.
- A critical review of the American Pain Society Clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions., Manchikanti L, Datta S, Gupta S, Munglani R, Bryce DA, Ward SP, Benyamin RM, Sharma ML, Helm S 2nd, Fellows B, Hirsch JA. Pain Medicine, Pain Management Center of Paducah, Paducah, KY, USA. Pain Physician. 2010 Jul;13(4):E215-64. via PubMed.org
- Transforaminal steroid injection for lumbar radicular pain proves superior to placebo, Ali Ghahreman, Richard Ferch and Nikolai Bogduk. Pain Medicine, Published Online: July 30, 2010 (DOI: 10.1111/j.1526-4637.2010.00908.x); Print Issue Date: August 2010.