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    An_249553 posted:
    Has anyone here received four (4) epidurals? I was under the impression only three were administered. The fourth one was so painful, I passed out.
    rosielou responded:
    Can you expand this a little? I've had 4 steroid injections at one time without any problem; cervical, lumbar, and both SI joints. Is that what you mean?
    ctbeth responded:
    Your MD will determine how many he/ she thinks is appropriate for you.

    It's usually, but not forbidden, to have a series of three and then be re-evaluated.

    They help some people very much, and others do not respond to them much, or at all.

    Good luck
    Peter Abaci, MD responded:
    What is an appropriate number of epidural injections? This is a pretty gray area, but I can give you some food for thought. Epidural cortisone injections are typically used to treat low back pain that radiates down the leg or neck pain that is radiating down an arm. Epidural injections can be considered in the sub-acute stage of symptoms and can provide time-limited relief.

    When I did my training in the 90s, the common practice for epidural steroid injections was to usually perform a series of three injections about 2-4 weeks apart. The feeling was there was a cumulative effect by doing them in a series. Once completed, we would advise patients to not repeat them for at least 6 months to get a break from the steroids. There seems to be a lack of outcome studies to support this practice, though, and in some cases, health plans may put restrictions on how many can be done. For example, some dictate that if the first one is not successful then there is no support to do additional ones, but I certainly have had patients over the years that didn't respond to the first one or two but felt great by the time the third one was completed.

    I like to factor in the age and life circumstances of the patient when deciding how many are appropriate. For example, for elderly patients who find them helpful in keeping more active, I don't mind them having a few every year. But for younger patients, I typically don't recommend them having steroid injections every year, year after year, if possible.

    If you don't feel as though you are making progress with your treatments, then certainly you should talk to your doctors about other alternative options and treatments.

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