Treatment Overview
Step 4: Interventional Procedures (Injections, Nerve Blocks)
When Steps 1–3 have not provided enough relief, injections or nerve blocks may be considered.
Common procedures
| Procedure | Target | Quality of Evidence |
|---|---|---|
| Epidural steroid injections | Nerve root pain (radiculopathy) | Moderate (limited benefit for axial back pain) |
| Facet joint injections/blocks | Facet joint pain | Low to very low |
| Radiofrequency ablation (RFA) | Facet joint pain | Very low (proper patient selection is critical) |
| Sacroiliac joint injections | Sacroiliac joint pain | Low |
A large network meta-analysis published in BMJ (Wang 2025, 132 studies, 7,977 patients) concluded that epidural injections for chronic axial low back pain (pain centered in the back itself, rather than radiating to the legs) "may result in little to no pain reduction."
Important: Injections are a temporary measure for pain relief — not a cure. Relying solely on injections is not recommended. They work best when used alongside active treatments like exercise and physical therapy.
Availability and frequency
Epidural steroid injections are more commonly offered in the United States than in many other countries. In the UK, NICE guidelines are more restrictive about their use for back pain. Regardless of where you live, discuss the expected benefit and the evidence with your doctor before proceeding.