Practice Patterns and Perspectives on Epidural Steroid Injections by Interventional Pain Physicians

Sara Abdullah; Jun Beom Ku; Olivia Sutton; Jatinder Gill; Robert J Yong; Omar Viswanath; Christopher L Robinson; Jamal Hasoon

doi:10.1007/s40122-025-00772-0

Practice Patterns and Perspectives on Epidural Steroid Injections by Interventional Pain Physicians

Pain Ther. 2025 Dec;14(6):1735-1743. doi: 10.1007/s40122-025-00772-0. Epub 2025 Sep 19.

Authors

Sara Abdullah^#^{1

2}, Jun Beom Ku^#³, Olivia Sutton^#⁴, Jatinder Gill⁵, Robert J Yong⁴, Omar Viswanath^#^{6

7}, Christopher L Robinson^#⁸, Jamal Hasoon^#⁹

Affiliations

¹ Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
² Department of Anesthesiology and Intensive Care, Hamad Medical Corporation, Doha, Qatar.
³ Deparment of Physical Medicine and Rehabilitation, New York Medical College, New York, USA.
⁴ Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, USA.
⁵ Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA.
⁶ Creighton University School of Medicine, Phoenix, USA.
⁷ Mountain View Headache and Spine Institute, Phoenix, USA.
⁸ Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
⁹ Department of Anesthesia, Critical Care, and Pain Medicine, McGovern Medical School, UTHealth, 6431 Fannin, Houston, TX, 77030, USA. Jamal.J.Hasoon@uth.tmc.edu.

^# Contributed equally.

Abstract

Introduction: Epidural steroid injections (ESIs) are commonly used to manage chronic spinal pain. However, variations in ESI practices remain prevalent among interventional pain physicians. This study evaluates current practice patterns and perceptions of ESI efficacy to identify areas for potential standardization in clinical application.

Methods: A structured survey was distributed to interventional pain physicians via email and social media outlets, collecting data on several aspects of ESI practice: (1) the importance of precise injectate placement, (2) perceived effectiveness for axial versus limb pain, and (3) preference for fixed versus variable injectate volume based on contrast pattern spread. Responses were collected and analyzed to understand prevailing practice trends. The survey included a diverse group of pain management physicians representing different primary specialties and practice settings.

Results: Of the 94 respondents, 77.7% (73/94) selected that precise injectate placement is crucial for optimal outcomes, while 22.3% (21/94) did not view it as essential. Regarding pain type, 61.7% (58/94) selected that ESIs help with axial and limb pain, while 36.2% (34/94) found ESIs primarily effective for limb pain. Only 1.1% (1/94) selected that ESIs were beneficial solely for axial back pain, with one respondent selecting ineffectiveness for either pain type. For injectate volume, 69.2% (65/94) selected that they use a fixed volume for injection, while 30.9% (29/94) adjusted injectate volume based on contrast spread.

Conclusion: This survey highlights practice patterns among interventional pain physicians regarding ESIs, underscoring the value placed on targeted injectate placement and the perceived broad efficacy of ESIs for axial and limb pain. However, the variability in volume administration suggests a need for further research to explore the impact of fixed versus variable injectate volumes on clinical outcomes. These findings may influence future standardization efforts in ESI practice.

Keywords: Chronic pain; Epidural steroid injections; Interventional pain management; Pain management; Practice parameters; Radiculopathy; Spinal pain.