Abstract
Non-surgical treatments of back pain may have prolonged and lasting benefit. Epidural steroid injections is one of the non-operative managements of back pain. These injections are recommended in patients with signs and symptoms of nerve root irritation. Relief of pain is attributed to the anti-inflammatory effect of the steroid. Patients with acute radiculopathy have better response compared to patients with chronic symptoms. Improvement may not be noted until 6 days after the injection. The depression of the hypothalamic-pituitary-adrenal (HPA) axis lasts 3 weeks. While complications have been reported, these are rare. Intrathecal steroid injection is not advisable since polyethylene glycol, the vehicle used in depot steroid preparations, may cause arachnoiditis.
MeSH terms
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Anesthesia, Epidural
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Back Pain / drug therapy*
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Back Pain / etiology
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Bupivacaine
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Clinical Trials as Topic
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Epidural Space
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Glucocorticoids / therapeutic use*
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Humans
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Hypothalamo-Hypophyseal System / drug effects
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Injections / adverse effects
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Injections, Spinal
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Intervertebral Disc Displacement / complications
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Intervertebral Disc Displacement / drug therapy
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Intervertebral Disc Displacement / therapy
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Lumbosacral Region
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Methylprednisolone / therapeutic use
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Nerve Compression Syndromes / drug therapy
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Nerve Compression Syndromes / etiology
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Peripheral Nervous System Diseases / drug therapy*
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Pituitary-Adrenal System / drug effects
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Procaine
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Spinal Nerve Roots*
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Triamcinolone / therapeutic use
Substances
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Glucocorticoids
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Triamcinolone
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Procaine
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Methylprednisolone
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Bupivacaine