Epidural steroid injection in the management of chronic pain in pediatric patients

Back pain is one of the most disabling conditions affecting people of all ages, including children and adolescents. School absenteeism—parallel to missed work days in adults—increased health care utilization, sleep problems, eating problems, and restriction in hobbies are some of the issues these patients face. For many, the inability to identify the source of pain—as is the case in more than 50% of cases—can be frustrating. It is important to emphasize that a history of back pain in childhood/adolescence represents increased risk of low back pain and potential disability in adulthood. Teaching healthy lifestyle habits is crucial for functional rehabilitations of these patients. Focusing on the “physical” aspect of the pain has led to treatment failures and increased frustration, for both patients and physicians. In our institution, a multidisciplinary approach has been used successfully in the care of these psychosocially complex patients. Only a minority of patients are candidates for interventional pain procedures. Lumbar epidural steroid injection (ESI), followed by facet joint injection, is the most frequent intervention we use in patients with discogenic pain associated with radiculopathy.