The Relationship Between Repeated Epidural Steroid Injections and Subsequent Opioid Use and Lumbar Surgery
While the results of this study may have surprised the authors, as a practicing chiropractor I can tell you that it comes as no surprise. The authors evaluated within the VA system whether the use of epidural injections would reduce the use of opioid pain medication use and lumbar surgery. Well..they actually increased the frequency of patients being on medication and increased the likelihood that they would need surgery. This coincides with other research that epidurals do not have evidence of long term improvement.
As a chiropractor, I would look at two potential pathways. First, the culture surrounding the use of ESIs is one of outside intervention and fosters an attitude of helplessness in the patient–that the answer will come from outside help, not inside recovery. This attitude would lead to further interventions. Secondly, it is entirely possible that the sanctity of the spinal canal is intruded in this procedure, leading to some degree of localized inflammatory response and fibrotic healing, further confounding the initial presenting complaint.
The bottom line is that every possible conservative, non-invasive method should be tried first and the quick jump to interventions like ESIs will likely lead to a worse outcome.