In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect.  

Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs.  Over time, based on analysis of the research performed, and based on clinical experience, taking a more nuanced approach has proven to be the recommendation of most pain societies.

Listen as the doctors discuss some of the available literature, as well as their clinical experience regarding this high yield / practical topic.

 

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This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

References:

1. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?. Medicine (Baltimore). 2016;95(29):e4131.

2. Lee JH, Lee SH. Can Repeat Injection Provide Clinical Benefit in Patients with Lumbosacral Diseases When First Epidural Injection Results Only in Partial Response?. Pain Physician. 2016;19(2):E283-E290.

3. N. K. Arden, C. Price, I. Reading, J. Stubbing, J. Hazelgrove, C. Dunne, M. Michel, P. Rogers, C. Cooper, on behalf of the WEST Study Group, A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study, Rheumatology, Volume 44, Issue 11, November 2005, Pages 1399–1406.

4. Naveen S. Murthy, MD, Jennifer R. Geske, MS, Randy A. Shelerud, MD, John T. Wald, MD, Felix E. Diehn, MD, Kent R. Thielen, MD, Timothy J. Kaufmann, MD, Jonathan M. Morris, MD, Vance T. Lehman, MD, Kimberly K. Amrami, MD, Rickey E. Carter, PhD, Timothy P. Maus, MD, The Effectiveness of Repeat Lumbar Transforaminal Epidural Steroid Injections, Pain Medicine, Volume 15, Issue 10, October 2014, Pages 1686–1694