Back, neck, and arm/leg pain from herniated discs are common in service members because of the significant physical demands of military service. ESIs are being used in the military to treat back and neck pain as part of a comprehensive pain management plan (for more information on how the VA and DoD treat pain, check out HPRC's FAQ ). In combination with other pain treatments, they appear to be helpful at getting service members back to duty. 11 Overall, ESIs provide at least short-term relief that allows service members to engage in longer-term pain management techniques such as stretching, exercising, and physical therapy.
Although corticosteroid injections have been used for many decades to treat back pain, the effectiveness and safety of the drugs for this use have not been established, and at this time, corticosteroids are not FDA-approved for this use. In April 2014, the . Food and Drug Administration (FDA) warned that the injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events , including loss of vision, stroke, paralysis, and death. According to the FDA, patients should discuss the benefits and risks of epidural corticosteroid injections with their health care providers.
Epidural injections are often used to treat radicular pain, also called sciatica , which is pain that radiates from the site of a pinched nerve in the low back to the area of the body aligned with that nerve, such as the back of the leg or into the foot. Inflammatory chemicals (. substance P, PLA2, arachidonic acid, TNF-α, IL-1, and prostaglandin E2) and immunologic mediators can generate pain and are associated with common back problems such as lumbar disc herniation or facet joint arthritis . These conditions, as well as many others, provoke inflammation that in turn can cause significant nerve root irritation and swelling.