Context

Epidural steroid injections (ESI) are the most commonly performed intervention for chronic axial pain. In the USA alone, the number of ESIs administered to Medicare recipients almost doubled between 2000 and 2004 (from 740 845 to 1 437 962 procedures/year).1 A recent systematic review found high-quality evidence that ESI for sciatica results in small, short-term (>2 weeks but ≤3 months) improvements in pain and disability; however, neither effects remained significant at ≥12 months of follow-up.1 ESI are associated with adverse effects that may be related to the technical approach or due to the effect of the steroids themselves,2 but there is very limited …