Corticosteroid injections may be ineffective for low back pain

25 Aug

People who suffer from low back pain often turn to epidural corticosteroid injections for some relief. According to new research, however, such treatment fails to provide long-term respite, if any.
A man with low back pain
For patients with radiculopathy or spinal stenosis, epidural corticosteroid injections are unlikely to provide effective pain relief, according to the study.

Lead study author Dr. Roger Chou, of the Oregon Health & Science University in Portland, and colleagues publish their findings in the Annals of Internal Medicine.

Low back pain is the leading cause of disability worldwide. In the US, around half of all workers admit to experiencing symptoms of back pain each year, and approximately 80% of us will suffer a back problem at some point in our lives.

Primary treatment for low back pain involves nonsurgical options, such as narcotic pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs). Other nonsurgical treatments include epidural corticosteroid injections, administered directly to the epidural space in the spine.

Epidural corticosteroid injections work by reducing inflammation and, in turn, relieving pain. According to Dr. Chou and colleagues, the injections are commonly used for radiculopathy (inflammation of a spinal nerve) and spinal stenosis (narrowing of the spinal canal) – two conditions that cause radiating low back pain.

Use of epidural corticosteroid injections for these conditions is increasing, despite the fact that numerous studies have questioned their effectiveness for low back pain.

Epidural corticosteroid injections ‘perceived as more effective than they actually are’

For their study, the team reviewed 30 trials assessing the short- and long-term effects of epidural corticosteroid injections for individuals with radiculopathy or spinal stenosis, comparing them with a placebo.

Specifically, the researchers looked at how epidural corticosteroid injections impacted patients’ pain, function and risk for surgery.

Fast facts about back pain

  • Around 31 million Americans experience back pain at any given time
  • Back pain is one of the most common reason for missed work days, and it is the second most common reason for doctors’ visits
  • Back pain costs Americans around $50 billion annually.

Learn more about back pain

While the injections provided greater immediate pain relief for radiculopathy than a placebo, the team found that this effect was small and short term. What is more, the treatment did not prevent patients’ need for surgery in the long term.

For spinal stenosis, the researchers found epidural corticosteroid injections offered patients no significant pain relief compared with placebo.

These findings remained regardless of what injection techniques and corticosteroids were used, according to the authors.

While severe side effects from corticosteroid injections were rare, some minor side effects were identified, which included bleeding, blood clots and nerve root irritation.

Talking to Reuters, Dr. Chou said epidural corticosteroid injections are being perceived as much more effective for low back pain than they actually are.

“Unfortunately, there are not a lot of great treatments for these conditions besides surgery, so the options for treatment are limited,” he added. “I do let patients know that the natural history for both of these conditions is for improvement over time.”

However, the results of this study have been met with some criticism. Dr. Zack McCormick, of the Northwestern University Feinberg School of Medicine in Chicago, IL, told Reuters that the trials analyzed in this research were of low quality, so the findings “cannot be applied to the realistic day-to-day practice of spine medicine.”

He noted, however, that the aim of epidural corticosteroid injections is to improve short-term symptoms and quality of life for the patient, not to provide a long-term cure. As such, he says the treatment should “not be used as an isolated therapy.”

Earlier this year, a study published in The BMJ found acetaminophen to be ineffective for lower back pain and osteoarthritis.

Written by Honor Whiteman

Copyright: Medical News Today

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