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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How far apart should spinal Epidural shots be given?

Answered by
Dr. Dariush Saghafi


Practicing since :1988

Answered : 2426 Questions

Posted on Wed, 25 May 2016 in Brain and Spine
Question: how far apart should spinal epidural shots be given? dr recommends 1 a week for the next four weeks in my L4-L5 lower back... I am scared. this is a workers compensation dr. your thoughts
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Frequency schedule depends on type of steroid and severity of injury

Detailed Answer:
Good morning. There is some controversy and debate surrounding the exact timing of epidural injections since several variables such as intensity of pain, acuteness of the injury and severity of the injury suffered, degree of responsiveness of the patient to standard oral medications, and previous responses and reactions of the patient to epidural injections are taken into considerations.

Epidural injections are essentially anesthetics mixed with a steroid base. For example, methylprednisolone (Trade name: SOLUMEDROL) is said to remain in the injection site for up to 2 weeks therefore, many pain management specialists will not dose methylprednisolone based epidurals for a minimum of 2 weeks and only after evaluation of the site and patient and how much relief they actually received. If the steroid being used is of shorter longevity then, injections can be given more frequently. Also, if pain is extremely intense or the severity of the injury itself was intense then, time between injections can be lessened to weekly or every 10 days.

In general, it is highly recommended that the injector re-evaluate the patient at least every 2 weeks or whatever the half life of the steroid is being used to determine what a good schedule would be for the patient and to gauge the effectiveness of the medication. It is true that some injections can be given weekly and I've seen injections given even every 3rd or 4th day under certain circumstances. The injector SHOULD be available to check his epidural steroid patients between shots and to only schedule and administer additional shots if the benefits outweigh the risks.

Injectors should be fully aware of the practice standards and guidelines for maximum dosing of certain regimens and based upon medication safety concerns.

In response to your question I have seen patients getting injected once weekly for several weeks consecutively but steroids used in those cases didn't have the same half life and tended to wash out much more quickly compared to other steroids. I always re-evaluate my patients prior to re-injection and usually have an extensive examination and history sessions between injections just to justify the use of more rounds as opposed to just started a regimen with a fixed number of shots no matter what happens to the patient.

If you are unsure of what the doctor is proposing then, your best bet is to postpone the procedure until you've had a chance to meet with him. Have him explain the rationale of weekly injections as opposed to what most people seem to go for which is either monthly or bimonthly injections. There is nothing that says you MUST have these injections.

I've rarely set up that many injections with someone without really checking them over between shots to determine what if any improvements are going on or having very good reasoning to load with that much steroid.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

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This consult request has taken a total of 33 minutes of time to read, research, and respond.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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