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

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 …