Skip to Main Content




Corticosteroids have been a mainstay in the area of interventional pain management because of their clinical effectiveness in treating numerous inflammatory subacute and chronic pain conditions. These conditions often include significant inflammatory components as seen in certain neuraxial, intra-articular and extra-articular disorders.




Hollander introduced the concept that injected corticosteroids can have a positive effect on inflammatory pain conditions in 1950. Since Hollander’s study, the role of corticosteroids has expanded into treating many other types of acute and chronic pain conditions such as degenerative and inflammatory conditions of the peripheral joints and the spine.6


The common indications for corticosteroids in interventional pain medicine can be broadly divided into the following categories:


  • Peripheral joints

  • Extra-articular tissue (eg, bursa)

  • Neuraxial structures and spaces (eg, facet joints, epidural space)


Epidural steroids were introduced into the United States in the 1960s and are the most commonly performed spinal interventions in the United States with an annual estimated Medicare spending of 175 million dollars in 2001. Studies have shown that epidural steroid can be effective in the treatment of painful radiculo­pathy from:


  • Disc herniations

  • Spondylolysis

  • Spinal stenosis

  • Annular tears

  • Degenerative conditions of cervical and lumbar spine


Other diseases that may benefit from corticosteroid injections include:


  • Osteoarthritis of the spine and peripheral joints

  • Rheumatoid arthritis and extra-articular disorders

  • Tendinitis

  • Bursitis

  • Ligament sprain

  • Tenosynovitis

  • Other overuse syndromes




The contraindications are more a function of the specific injection being performed rather than whether if cortisone should be included in the injectate. Active infection at the needle insertion site must be considered before all injections although this at times may prove difficult to differentiate from noninfectious arthropathies. Bleeding disorders are especially important in neuraxial procedures as they can lead to paralysis if the physician is not appropriately vigilant. The absolute and relative contraindications for corticosteroid injections are listed in Table 6-1.

Table Graphic Jump Location
TABLE 6-1.Absolute and Relative Contraindications to Corticosteroid Injection



  • Cortisol is an endogenous glucocorticoid required for normal cellular function synthesized in the zona fasciculata of the adrenal cortex.

  • It is essential for normal metabolism, wound healing, gluconeogenesis, lipolysis, and immunologic activity.

  • It has significant anti-inflammatory actions that are beneficial in the treatment of chronic pain conditions.

  • Cortisol is under the control of the hypothalamic-pituitary-adrenal axis (HPA).

  • In the presence of a stressor, the hypothalamus releases ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.