BMJ  2004;328:1509-1510 (26 June), doi:10.1136/bmj.328.7455.1509

Editorial

Is epidural injection of steroids effective for low back pain?

The evidence is equivocal, but clinical experience favours its use in some patients

The first 150 words of the full text of this article appear below.

Low back pain is a problem that is common and costly to society, and its effective management remains a challenge.^{1 2} Exercise programmes combined with early return to normal activities have been shown to be beneficial in chronic low back pain.^2-3 Other interventions may also have a beneficial effect, and epidural injection of steroids represents one such alternative. This editorial examines the evidence to determine whether such treatment is justified.

In clinical practice a structured approach at the initial consultation facilitates the evaluation of patients with low back pain.⁴ The presence of "red flag" signs indicates possible serious underlying pathology and warrants urgent referral to a specialist unit.⁵ Usually, "leg pain dominant" features indicate lumbosacral nerve root irritation or entrapment, whereas "back pain dominant" features indicate a biomechanical cause. Mechanical back pain may often be associated with some nerve root irritation, or present as an exacerbation of chronic symptoms.

The therapeutic . . . [Full text of this article]

Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW (ash.samanta@uhl-tr.nhs.uk)

Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW

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Rapid Responses:

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Potemkin would have used steroids

Dr. Herbert H. Nehrlich
bmj.com, 25 Jun 2004 [Full text]

Unannounced side effect of epidural steroids

Zana A Gentle, et al.
bmj.com, 25 Jun 2004 [Full text]

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Cynthia M Lewis
bmj.com, 25 Jun 2004 [Full text]

Need of a clinical trial for epidural steroid inection in low back pain.

Milind S Deogaonkar
bmj.com, 25 Jun 2004 [Full text]

Epidural - problems

Jon Madura
bmj.com, 25 Jun 2004 [Full text]

epidural steroid injections

linda coleman
bmj.com, 28 Jun 2004 [Full text]

Epidural Steroids Dangerous and Full Disclosurre Rarely Given

Jeff Felicetti
bmj.com, 28 Jun 2004 [Full text]

Epidural Steroids for Low Back Pain: No Evidence

Edward M. Walsh
bmj.com, 28 Jun 2004 [Full text]

Since When?

Barbara S Welch
bmj.com, 28 Jun 2004 [Full text]

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Gary A Snook
bmj.com, 28 Jun 2004 [Full text]

Depo Medrol DID Harm Me

Mary J Reyerson
bmj.com, 28 Jun 2004 [Full text]

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Bob Smith
bmj.com, 28 Jun 2004 [Full text]

Royal Society of Anaesthetists / Pain Society Recommendations

Sue G. Clayton
bmj.com, 29 Jun 2004 [Full text]

Epidural

Isobel Knight
bmj.com, 29 Jun 2004 [Full text]

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Kieran M Walsh
bmj.com, 30 Jun 2004 [Full text]

The Epidurals Changed My Life Forever

Martha E Lyles
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Lina J Talbot
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Guy S Wildy
bmj.com, 3 Jul 2004 [Full text]

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Dennis J. Capolongo
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making a diagnosis

Judith Neaves
bmj.com, 11 Aug 2004 [Full text]