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Single Epidural Injection: A Novel Approach to Relieve Neck and Back Pain Simultaneously?

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Lena Kashyap in Health & Wellness October 2026 • 4 min read.

"Discover how a single epidural injection, combined with a simple table tilt, could revolutionize pain management for cervical and lumbar radiculopathies."


Chronic neck and back pain affects a significant portion of the population, often stemming from radiculopathy caused by intervertebral disc issues. Traditionally, addressing radiculopathy at multiple levels requires multiple epidural steroid injections, but what if there was a way to manage pain in both the cervical and lumbar regions with just one shot?

A groundbreaking study explores the effectiveness of a single epidural injection combined with a simple table tilt technique to manage radiculopathies affecting both the neck and lower back. This approach aims to provide comprehensive pain relief without the need for multiple injections, potentially reducing discomfort and costs for patients.

This innovative method involves injecting a combination of local anesthetic, tramadol, and methylprednisolone into the lumbar epidural space, followed by tilting the patient on a table to facilitate the spread of the medication to the cervical region. The study assesses the outcomes and immediate complications of this single-injection technique, offering new hope for those suffering from combined cervical and lumbar radiculopathies.

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Epidural Use and Reach

Epidural administration delivers medication into the epidural space around the spinal cord. Physicians and nurse anesthetists use this route for local anesthetics, analgesics, diagnostic medicines such as radiocontrast agents, and other medications. Epidural injections are also used for pain during and after surgery and for pain management. Cleveland Clinic notes that how long an epidural lasts depends on whether it is used for anesthesia or as a steroid injection for chronic pain, while American Pregnancy reports that more than 50% of women giving birth at hospitals use epidural anesthesia.

Established Options

Epidural treatment is generally selected according to the intended goal, such as anesthesia, postoperative pain relief, or management of chronic pain. A single injection may not provide the same duration or effect as a continuing anesthetic approach or a steroid injection. The appropriate method depends on the condition being treated and the clinician's assessment. Because benefits and limitations vary by patient and purpose, a single injection should not be assumed to relieve pain in every affected region.

A Longstanding Choice

Epidural anesthesia has become a familiar option in labor and delivery, where choosing it is typically described as a matter of personal preference. Cleveland Clinic presents the decision through both potential advantages and disadvantages rather than as a universally appropriate intervention. This history helps explain why epidural treatment is widely recognized while still requiring individualized consideration. Its established use does not by itself demonstrate that one injection can reliably address neck and back pain simultaneously.

How Does a Single Epidural Injection Work for Dual Pain Relief?

Spine with glowing nerve pathways, table tilt, pain relief concept

The study included 50 patients aged 35-65 years, all experiencing both cervical and lumbar radiculopathic pain. These patients underwent a single lumbar epidural injection containing a mix of local anesthetic, tramadol, and methylprednisolone while positioned on their side. After the injection, the table was tilted into the Trendelenburg position at a 25-degree angle for 10 minutes before returning the patient to a supine position. This process was repeated three times, with two weeks between each injection.

The key to this technique lies in the Trendelenburg position, which uses gravity to help distribute the injected medication throughout the epidural space, reaching both the lumbar and cervical regions. This ensures that the anti-inflammatory and analgesic effects of the drugs target both areas of radiculopathy, providing comprehensive pain relief.

  • Patient Selection: 50 patients with cervical and lumbar radiculopathy.
  • Injection Composition: Local anesthetic, tramadol, and methylprednisolone.
  • Positioning: Lateral position during injection, followed by Trendelenburg tilt.
  • Tilt Angle: 25 degrees for 10 minutes.
  • Repetition: Three injections, two weeks apart.
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Evidence Still Matters

Any evaluation of a single epidural injection should distinguish established clinical use from evidence about treating neck and back pain at the same time. Outcomes may depend on the condition, the medication used, and the intended duration of relief. Without direct comparative evidence, claims that this approach is novel or broadly effective should remain cautious. Clinical decisions are best based on patient-specific assessment and appropriately designed research.

Limits and Uncertainty

A single injection may not produce lasting relief for every patient or address pain arising from different spinal regions. Treatment response can vary with the underlying cause, the medication selected, and the goal of treatment. The possibility of incomplete or temporary benefit is therefore relevant when considering a combined approach. A promising concept should not be treated as a guaranteed solution.

Comparing Treatment Strategies

A fair comparison would examine a single epidural injection alongside region-specific injections, medication-based care, physical rehabilitation, and other appropriate options. The comparison should consider pain relief, duration, functional improvement, risks, and the need for repeat treatment. These measures may differ between neck and back conditions. Without direct evidence, no approach can be declared superior for simultaneous symptoms.

The results showed promising outcomes, with 74% of patients experiencing complete resolution of symptoms after the three injections. Another 18% reported partial relief, while only 8% did not benefit from the procedure. Immediate complications were minimal, with some patients experiencing nausea, vomiting, or minor issues like hypotension or high block.

A Promising Alternative for Pain Management

This single-injection technique offers a potentially effective and less invasive alternative to traditional methods requiring multiple injections. By using a combination of medication and a simple table tilt, patients can experience significant pain relief in both the cervical and lumbar regions, improving their overall quality of life. This method could be a game-changer for managing combined radiculopathies, providing a more convenient and cost-effective solution.

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A Conditional Approach

A single epidural injection may be a reasonable subject for clinical discussion when neck and back pain coexist, but its suitability depends on the source and pattern of pain. The concept should be framed as individualized treatment rather than a universal shortcut. Clinicians must weigh expected benefit against uncertainty and potential limitations. Patients should receive a clear explanation of alternatives and realistic expectations.

Questions for Future Study

Future research could clarify which patients, medications, and injection techniques are most appropriate for simultaneous neck and back symptoms. Studies should assess both short-term relief and longer-term function. They should also compare a single injection with region-specific and noninvasive strategies. Until such evidence is available, the approach remains an area for careful investigation rather than a settled standard.

Care Beyond the Injection

Neck and back pain can involve different causes, so a single procedural solution may not fit every patient. Access to qualified assessment, appropriate imaging when indicated, rehabilitation, and follow-up can influence real-world outcomes. Health systems also need to balance procedural treatment with conservative and multidisciplinary care. These broader factors matter when judging whether an injection is genuinely useful.

Patient-Centered Decisions

Pain affects daily function, comfort, and personal priorities, making patient goals central to treatment decisions. Some people may value a potentially convenient single procedure, while others may prefer approaches that avoid injections or emphasize rehabilitation. Clear communication about expected relief, uncertainty, and possible repeat care supports informed choice. The most meaningful outcome is improved function and quality of life, not simply completion of a procedure.

Limits identified in the injection study

  • Because the study had no control group, its results cannot separate the treatment’s effects from changes that might have occurred without it.[1]
  • The authors cautioned that their conclusions about efficacy and safety do not extend to cervical transforaminal epidural steroid injections.[1]
  • For cervical and lumbar disc herniation, the paper states that separate injections are warranted, limiting the scope of its proposed single-injection approach.[1]
  • The paper also says that two distinct levels of radiculopathy call for separate injections, so its conclusion does not cover every multi-level case.[2]

The study at a glance

PopulationPatients aged 35 to 65 years with combined cervical and lumbosaccral radiculopathy on one side[2]
Sample size50[2]
SettingAuthors' clinic[2]
DurationMean follow-up of 4 to 5 years[2]
Main outcomePain relief assessed using a visual analogue scale[2]
Effect sizeVery good relief in 37 (74%); good response in 9 (18%); no significant pain relief in 4 (8%)[2]
Times cited14[2]

How later papers place this approach

Other cited work addresses lumbar injection approaches or cervical radicular pain, but the excerpts do not provide a direct comparison with this combined neck-and-back method.[3] [4] [5]

Sources

  1. Single Shot Epidural Injection for Cervical and Lumbosaccral Radiculopathies: A Preliminary Study (Europe PMC, 2010)
  2. Single Shot Epidural Injection for Cervical and Lumbosaccral Radiculopathies: A Preliminary Study (Korean Pain Society, 2010)
  3. A COMPARATIVE STUDY TRANSFORAMINAL VERSUS INTERLAMINAR EPIDURAL STEROID INJECTION IN MANAGEMENT OF SYMPTOMATIC LUMBAR DISC HERNIATION. (2018)
  4. Comparison of epidural space contrast flow and clinical outcomes in parasagittal versus transforaminal epidural steroid injection (2026)
  5. The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3344/kjp.2010.23.4.254, Alternate LINK

Title: Single Shot Epidural Injection For Cervical And Lumbosaccral Radiculopathies: A Preliminary Study

Subject: Anesthesiology and Pain Medicine

Journal: The Korean Journal of Pain

Publisher: Korean Pain Society

Authors: Digambar Prasad Nawani, Sanjay Agrawal, Veena Asthana

Published: 2010-12-31

Everything You Need To Know

1

What is radiculopathy, and how does it typically lead to the need for epidural steroid injections?

Radiculopathy refers to a condition where one or more nerves are affected, leading to pain, numbness, weakness, or tingling in the arms or legs. It often arises from issues with the intervertebral discs that compress or irritate the spinal nerves. Traditionally, addressing radiculopathy affecting multiple levels requires multiple epidural steroid injections to target each specific area of nerve impingement. However, the single epidural injection technique aims to provide relief to both cervical and lumbar regions with just one injection, potentially reducing the need for multiple procedures.

2

How does the single epidural injection technique using a Trendelenburg position actually work to alleviate both neck and lower back pain?

The single epidural injection technique involves injecting a combination of local anesthetic, tramadol, and methylprednisolone into the lumbar epidural space. Following the injection, the patient is placed in the Trendelenburg position, tilting the table at a 25-degree angle. This position uses gravity to facilitate the distribution of the injected medication throughout the epidural space, allowing it to reach both the lumbar and cervical regions. The anti-inflammatory and analgesic effects of methylprednisolone, tramadol and the local anesthetic then target both areas affected by radiculopathy, providing comprehensive pain relief. Without the Trendelenburg position, the medication might not effectively reach the cervical region, limiting the scope of pain relief.

3

What were the primary medications used in the single epidural injection, and what is the purpose of each?

The single epidural injection used a combination of three medications: a local anesthetic, tramadol, and methylprednisolone. The local anesthetic provides immediate pain relief by numbing the area. Tramadol is an opioid analgesic that helps to manage pain signals. Methylprednisolone is a corticosteroid that reduces inflammation around the affected nerves. The combination of these medications aims to provide both immediate and longer-term relief by addressing both the pain and inflammation associated with radiculopathy. The study did not mention using other types of medications or their impacts. Therefore, this approach may be limited to only those three medications.

4

What were the outcomes of the study using the single epidural injection technique, and what were the most common immediate complications observed?

The study showed promising outcomes, with 74% of patients experiencing complete resolution of their symptoms after three injections. Additionally, 18% reported partial relief. Immediate complications were minimal, with some patients experiencing nausea, vomiting, minor hypotension, or high block. While the study focused on these immediate complications, it did not extensively discuss longer-term risks or side effects, which would be important to consider in a broader clinical context.

5

What are the potential benefits of using a single epidural injection combined with the Trendelenburg table tilt compared to traditional methods for treating cervical and lumbar radiculopathy?

The single epidural injection technique, combined with the Trendelenburg table tilt, offers several potential benefits compared to traditional methods that require multiple injections. It is a less invasive alternative, reducing the number of needle punctures and, consequently, the risk of infection or other complications associated with multiple injections. By targeting both the cervical and lumbar regions with a single injection, it provides a more convenient and potentially more cost-effective solution for patients experiencing combined radiculopathies. The study also suggests that this method can lead to significant pain relief and improved quality of life for patients. However, it's important to note that the study only included a specific combination of medications and a particular patient demographic, so the generalizability of these benefits may vary.

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