July 19, 2008

Sciatica and the Epidural: Are You a Candidate?

Ever since my article on Sciatica and Epidural Injections, I’ve received a number of emails requesting more information on the subject. Therefore, I’ve decided to expand that original post into a series of articles to answer your many questions and to clear up some misconceptions.

And, since I’m not very creative, I’ve decided to just start with the two most common questions:

  1. What exactly are epidural steroid injections? and…
  2. How can I tell if they will work for me?

What is an Epidural Steroid Injection?


Epidural steroid injections are a method your doctor can use to deliver a drug directly into an area of inflammation. These drugs (corticosteroids or glucocorticoids) are very similar to cortisal, a natural hormone produced by the adrenal gland.

These particular steroids act on the immune system to prevent it from overproducing the chemicals that cause inflammation in an injured area.

Inflammation is a by-product of the body’s defense mechanism. It is a natural process and not necessarily a bad thing. However, it can be a bit of a nuisance. Just ask anyone dealing with the numbness, tingling, loss of muscle control, pain and other symptoms we’ve come to know as sciatica.

Doctors and therapists have found that reducing this inflammation can greatly reduce your discomfort. While reducing the discomfort is not the same thing as a cure, for some, it can be the leg-up they need in order to proceed with a good rehabilitation program.

Are You a Candidate?

To determine if epidural steroid injections would help you, your doctor will first prescribe an oral steroid such as methylprednisolone. This medication is often used to treat inflammation and swelling associated with arthritis.

If you respond favorably to the oral steroid, it is very likely that you will have good results with the epidurals.

Typically the 4 mg tablets are taken over 6 days in decreasing dosages as follows:


  • Day 1: 6 tablets
  • Day 2: 5 tablets
  • Day 3: 4 tablets
  • Day 4: 3 tablets
  • Day 5: 2 tablets
  • Day 6: 1 tablet

It may take from 4 to 6 days before you notice any results from the oral steroid and those results may be very slight. That’s okay. Even a minor improvement in your symptoms means the epidurals will probably work for you.

In closing…

Keep in mind that epidural injections don’t work for everyone and I’m not advocating for them one way or the other. That’s for you to decide after consulting with your doctor.

In the next installment, we’ll take a look at the difference between corticosteroids and anabolic steroids. Suffice it to say, they are not the same thing.

Till then,


1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.