Steroids are used to fight inflammation and speed healing. For injuries, this treatment may be a good idea, but for most back pain scenarios, I always ask, where is the inflammation? As Dr. Sarno has pointed out time and time again, there is rarely evidence of any inflammatory process in the majority of chronic pain complaints. Even in cases where inflammation exists, steroids are not a very good option, since they are often completely ineffectual or only provide short term benefits, sometimes only due to the placebo effect.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.