 Epidural steroid injections, ESIs, are a commonly used treatment for spinal pain, but they have potential side effects such as HPA axis suppression, adrenal insufficiency, Cushing's syndrome, hyperglycemia, osteoporosis, and immune disorders. Nonparticulate steroids are preferred over particulate steroids to reduce these risks. Additionally, the frequency and dose of ESIs should be determined by the degree of HPA axis suppression, which can be measured through blood tests. This article was authored by Men Suli and Hosik Moun.