ABSTRACT
Epidural injection of corticosteroids is commonly used for managing chronic spinal pain and other painful conditions. Several approaches are available to access the lumbar epidural space: caudal, interlaminar, and transforaminal. The mechanisms of action of epidural injections are not well understood, but it is believed that neural blockade alters or interrupts nociceptive or neuropathic mechanisms. Explanations for improvement are based in part on the pharmacological and physical actions of local anesthetics, corticosteroids, and other agents. Effects may occur at spinal roots, dorsal root ganglia, and the dorsal horn. It is probable that the steroid component of the injection has an anti-inflammatory component, although there may be effects on neural excitability as well.
