Cortisone Shots for Back and Neck Pain: The Facts

Dr. Craig Brue, DC

Are you experiencing recurring episodes of back and neck pain, sciatica, numbness in the hands, arms, or legs? Has your doctor recommended a referral to a pain management doctor for a cortisone shot? Before you consider an epidural steroid shot (ESI), here are the facts you need to know.

Fact 1: Epidural Steroid Injections are not approved by the FDA.

Epidural steroid shots are not approved by the Food and Drug Administration for injection into the epidural space to treat neck and back pain that radiates pain into the arms and legs. However, epidural shots are being allowed as an off-label use.

Fact 2: There are serious risks associated with ESI’s.

Side-effects include allergic reactions, hematoma, stroke, paralysis, infection, and death.

Fact 3: ESI’s are typically short-acting and ineffective over the long term.

Dr. Nancy Epstein, a neurosurgeon with Winthrop University Hospital in New York, after researching the effectiveness of ESI’s states, “The multitude of risks attributed to these injections outweighs the benefits.”

Fact 4: ESI’s do not show any reduction in the rate of subsequent spinal surgery.

In fact, a recent study by researchers at Thomas Jefferson University in Philadelphia documents that “patients who received ESI’s had a higher rate of crossover to surgery and fared worse in physical health and bodily pain versus those who did not receive ESI’s.” The study notes that patients receiving injections were more likely to require subsequent spinal surgery.

Fact 5: Epidural shots are expensive.

The average cost for an epidural shot is $2500. In addition, an ESI is only performed after an expensive workup; doctor’s evaluation, and MRI studies. A recent Bloomberg article, “Epidurals Linked to Paralysis Seen With $300 Billion Pain Market,” states that the significant increase in the use of ESI’s is related to the “generous reimbursements for treatment. If you pay people to do stuff, they will do more stuff.”

Fact 6: Not all doctors are qualified or properly trained to give ESI’s.

Although almost any MD can administer a spinal injection, Dr. Richard Rosenquist, a pain management doctor with the Cleveland Clinic, warns, “The unsuspecting public has no idea someone might have gone to a weekend course and is testing out their brand new skill on you. It’s horrible.”

Fact 7: Evidence-based medicine states that ESI’s should be given only after conservative management has failed.

Dr. Oz recently interviewed Reza Ghorbani, MD, a Harvard-trained pain specialist, about ESI’s. They both agreed that patients should not receive ESI’s for neck/shoulder/arm or back/leg pain until conservative management, including chiropractic care and physical therapy, has failed.

My advice: Before considering expensive and potentially dangerous cortisone shots in your spine, consider a safe, alternative approach; chiropractic care. You may have nothing to lose except the pain you are experiencing.

Dr. Brue is an author, lecturer, and chiropractic provider located in SaddleBrooke, Ariz. For more information on the effectiveness of chiropractic care, go to