Epidural Steroid Injection Frequency Limit — FRCA Final MCQ

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EasyPain MedicineEpidural Steroid Injection Frequency LimitFRCA Final

A 40-year-old man with chronic back pain sees an interventional pain physician who recommends a lumbar epidural steroid injection. According to Faculty of Pain Medicine guidelines, what is the maximum number of epidural steroid injections recommended per year?

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Correct answer: C — 3

The Faculty of Pain Medicine and NICE recommend a maximum of 3 epidural steroid injections per year (with at least 6 weeks between injections). This limit is based on concerns about: cumulative steroid side effects (HPA axis suppression, bone density loss, hyperglycaemia), potential neural toxicity from repeated preservative exposure, and diminishing clinical returns. If 3 injections have not provided sustained relief, an alternative management strategy should be discussed. Epidural steroids provide temporary (weeks to months) pain relief for radicular pain.

Reference: Faculty of Pain Medicine – 2021 – Interventional pain procedures; NICE – 2024 – NG59 Low back pain