The one thing that surgeons and regenerative medicine specialists agree on is the question being raised in the medical literature asking whether patients have been informed of the poor likelihood of long-term steroid injection treatments success for disability.

A study conducted in March 2025 (1) looked at earlier research to evaluate pain levels and the impact of that pain on daily activities for patients suffering from lumbar radicular pain after receiving epidural corticosteroid injections and platelet-rich plasma (PRP). This review analyzed seven studies, which included four randomized controlled trials and three prospective studies, involving a total of 416 patients. The findings indicated that corticosteroid injections allowed patients to move and function more effectively in the short term compared to PRP. However, as time went on, there were no significant differences in pain levels or daily functioning between the two treatment options showing PRP was equally effective and without possible detrimental side effects of steroids.

A paper from December 2025 (2) states that several studies have shown PRP injections are better than regular epidural steroid injections for reducing radicular leg pain and enhancing functional results, while also having fewer side effects. This emphasizes PRP’s good safety and tolerability. Since PRP is made from the patient’s own blood, it sidesteps the possible issues linked to steroids, like immunosuppression, osteoporosis, and neurotoxicity. This makes PRP especially appropriate for patients who do not respond well to standard treatments or have reasons not to use them.

A study from May 2023 (3) looked at how transforaminal steroid injections compared to platelet-rich plasma (PRP) injections for individuals suffering from discogenic lumbar radiculopathy.

  • Sixty patients participated in this research. They were randomly divided into two groups:
    • one received a single PRP injection (29 patients), while the other got a single steroid injection (31 patients).
  • The doctors assessed their pain and functionality using the Visual Analogue Scale (VAS), the modified Oswestry Low Back Pain Disability Index (MODI), and the straight leg raise test (SLRT). These assessments were conducted before the treatment and again at 1, 3, and 6 months post-injection.

Results Both groups showed improvement after the treatment, with lower pain and disability scores.

  • The PRP group experienced significant enhancements in pain and function that persisted through all follow-up periods (1, 3, and 6 months). In contrast, the steroid group only showed this level of improvement at 1 and 3 months.
  • Steroid injections were more effective at 1 month, but PRP yielded better outcomes at 6 months. At the 3-month mark, there was no distinct difference between the two treatments.
  • After 6 months, over 90% of the PRP group had a negative straight leg raise test (indicating vast improvement), while only 62% of the steroid group achieved this. Although both PRP and steroid injections provided short-term benefits (up to 3 months), the PRP injections continued to offer significant advantages for up to 6 months.

16 years of research questioning steroids

Below are some studies conducted over the last 16 years.

From Vanderbilt University:

  • When studied side-by-side against many different lumbar disc problems, surgery is superior to epidural steroid injections for improving quality of life and pain, however after a year neither the surgery or the epidural steroid injections significantly helped improve the patient’s disability.(4)

“…epidural steroid injection cannot alter the need for surgery in the long term.”

Epidural steroid injections do not prevent surgery, they provide pain relief until the day of surgery. From Johns Hopkins School of Medicine, Walter Reed National Military Medical Center, University of Toronto researchers:

  • Epidural steroid injections provide modest pain relief up to 3 months in patients with lumbosacral radicular pain caused by herniated disks, but they have no impact on physical disability or incidence of surgery.(5)

From The Chinese University and Prince of Wales Hospital in Hong Kong:

  • The immediate response to transforaminal epidural steroid injection was approximately 80%. . . However transforaminal epidural steroid injection cannot alter the need for surgery in the long term.(6)

From the Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute

  • For some epidural steroid injections did not work at all. “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.”(7)

This is from Stanford University

“Despite a high success rate at 6 months, the majority of (patients) experienced a recurrence of symptoms at some time during the subsequent 5 years. Fortunately, few reported current symptoms, and a small minority required additional injections, surgery, or opioid pain medications. Lumbar disc herniation is a disease that can be effectively treated in the short-term by transforaminal epidural steroid injections or surgery, but long-term recurrence rates are high regardless of treatment received.”(8)

Epidural steroid injection the most frequently performed pain procedure, dangerous?

In a review published by Dr. Epstein from the Albert Einstein School of Medicine in the medical journal Spine, Epidural steroid injections were not only questioned for lack of effectiveness, but also called dangerous:

  • “(Epidural steroid injections) are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications. . .Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits.”(9)

Epidural steroid injection side effects

Epidural steroid injections are given to reduce inflammation in the nerves that pass through the spinal canal. Many pain management specialists believe that nerve inflammation is the root cause of the patient’s discomfort and the cause of radiating pain and numbness down the patient’s legs. Patients with these problems are often diagnosed as having “Sciatica,” a term to describe injury or compression of the sciatic nerve. Dr. Alison Stout of the Spine and Musculoskeletal Medicine, Rehabilitation Care Services, Veterans Administration said: “Epidural steroid injection has been used as a treatment for low back pain for over 50 years. In the last 10 to 15 years, there has been a significant increase in (their use) for the treatment of low back pain and radicular pain without clear improvements in outcomes.” As chronic pain specialists we see many patients with radiating lower back pain. When we first examine these patients at least 25% of them will say that they have been diagnosed with sciatica. After the examination we find that many of these patients do not have sciatica at all and this is why epidural steroid injections have failed them.

Dr. Darrow injecting the patient’s spinal ligaments to relieve discomfort.

When epidurals do not work

When epidurals do not work many physicians will move the patient unto surgery. Procedures will be recommended that will “stabilize the spine” such as spinal fusion, or surgeries or laser methods that will create more space for the nerves by removing bone from the vertebrae. This is why we see many patients with “Failed Back Surgery Syndrome,” a procedure was performed that did not address the cause of the patient’s pain ligament weakness or laxity.

Treatment options beyond epidurals and alternatives to surgery

In our clinic we offer our patients options that treat the cause of their pain and functional problems with stem cell therapy. Use the form below and ask me your questions about your back pain.

References:

1 Saraf A, Hussain A, Sandhu AS, Bishnoi S, Arora V. Transforaminal injections of platelet-rich plasma compared with steroid in lumbar radiculopathy: a prospective, double-blind randomized study. Indian Journal of Orthopaedics. 2023 Jul;57(7):1126-33.
2 Tong Y, Yu L, Luo K, Yan X, Chen M, Wang L. Recent advances and evolving strategies in the treatment of lumbar disc herniation. Frontiers in Neurology. 2025 Dec 19;16:1706784. [Google Scholar]
3 Wang X, Zhang Y. Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025 Mar 25;20(1):306.
4 Sivaganesan A, Chotai S, Parker SL, McGirt MJ, Devin CJ. 161 Patient-Reported Outcomes After Epidural Steroid Injections vs Surgery for Degenerative Lumbar Disease: A Prospective, Matched Cohort Study. Neurosurgery. 2016 Aug;63 Suppl 1:164-5. doi: 10.1227/01.neu.0000489730.99853.c3.
5 Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg. 2016 Mar;122(3):857-70. doi: 10.1213/ANE.0000000000001155.
6 .Leung SM, Chau WW, Law SW, Fung KY. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Medical Journal. 2015 Oct 1;21(5):394.
7 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.
8 Kennedy DJ, Zheng PZ, Smuck M, McCormick ZL, Huynh L, Schneider BJ. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. The Spine Journal. 2018 Jan 1;18(1):29-35.
9 Epstein NE The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature Spine: 2013;3:74-93 6. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am. 2010 Nov;21(4):825-34.