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Epidural Steroid Injections for Low Back Pain in Post Menopausal Women


In recent blogs we published medical findings that cast doubts on the efficacy of epidural steroid injections for low back pain. New research suggests that not only is their usefulness in doubt, but now post-menopausal women should avoid epidural steroid injections for chronic pain. Findings show that postmenopausal women are at risk for bone mineral density (BMD) loss when treated with these injections. Researchers in the medical journal Spine studied 28 post-menopausal women who were treated for radiculopathy with epidural steroid injections to L4-L5 in the low back. They recorded significant decline in the hip BMD at 6 months compared to baseline.

“…Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in BMD, while slight, suggests that ESIs should be used with caution in those at a risk for fracture.”1

Adding to the risks, other researchers found that epidural steroid injections cause abnormal uterine bleeding in pre and post-menopausal women.2 These are serious risks for a treatment with questionable effectiveness, as quoted in the Journal of Bone and Joint Surgery: “Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection.”3

However in more recent research, which some doctors are adhering to, epidural steroid injections were NOT associated with increased fracture risk.  But that research, as noted by the authors themselves was limited and may not entirely accurate.4 The fact is, the issue is confused and a patient needs to understand the risks of all medical treatments.

What Are Effective Low Back Treatments?

For the postmenopausal women, the great consideration for effectiveness of treatment should be one that does not have the risk of causing vertebrae fractures.  Other than that obvious factor, as we wrote in the Journal of Prolotherapy: “There is some consensus in the medical community on how to treat acute low back pain, but treatment of chronic pain presents many challenges and little agreement on standard of care. Nonsteroidal anti-inflammatory drugs and antidepressants provide some short-term benefit, but no published data warrant their long-term use.”5

Chronic low back pain is a very common problem for which there is currently no universally effective treatment. Patients with chronic low back pain have many treatment options and it is important for them to understand the evidence behind each treatment option they may be considering. Prolotherapy injections have been used to treat chronic low-back pain for over 50 years but their use remains controversial. They involve repeatedly injecting ligaments with compounds such as dextrose (sugar) and lidocaine (anaesthetic) to help restart the body’s natural healing process by causing controlled acute inflammation (swelling) in the areas injected. Proponents believe this leads to stronger ligaments that can better support the low back.

Prolotherapy injections are often combined with other treatments such as spinal manipulation, exercises, and corticosteroid injections into tender muscles to maximize its effect.6 You will find that Prolotherapy clinics that properly administer Prolotherapy injections, with both the right solution and number of injections, have great success in treating low back pain. In fact, the low back is one of the most common chronic pain areas treated with Prolotherapy. Prolotherapy comes with little risk and allows mobility throughout treatment. In most cases it is far superior to NSAIDs, steroid injections and surgery.


1. Al-Shoha A, et al. Effect of Epidural Steroid Injection on Bone Mineral Density and Markers of Bone Turnover in Postmenopausal Women. Spine doi: 10.1097/BRS.0b013e318270280e

2. Hirsch JG, Hsu ES. Abnormal uterine bleeding following lumbar epidural corticosteroid injections and facet medial branch blocks in both pre- and postmenopausal women: a case series. Pain Med. 2012 Sep;13(9):1137-40. doi: 10.1111/j.1526-4637.2012.01445.x. Epub 2012 Jul 30.

3 Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, Zhao W, Vaccaro A, Albert TJ, Weinstein JN. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation: A Subgroup Analysis of the SPORT Trial J Bone Joint Surg Am. 2012 Jun 27. doi: 10.2106/JBJS.K.00341. [Epub ahead of print]
4. Yi Y, Hwang B, Son H, Cheong I. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician. 2012 Nov-Dec;15(6):441-9.

5. Hauser RA, Hauser MA. Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study. Journal of Prolotherapy 2009;1:145-155

6. ibid., or Hauser RA, Hauser MA. Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study. Journal of Prolotherapy 2009;1:145-155


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