For low back pain, corticosteroid injections may not be effective
According to the new research, epidural corticosteroid injections, frequently used for the treatment of low back pain do not provide relief.The worldwide prevalence of low back pain is the main cause of disability. Each year, half of the all workers in U.S. are experiencing low back pain and it is also predicted that 80% of us will experience back pain in our lifetime. The major intervention for back pain includes non-surgical medications like narcotics and NSAIDs. Epidural corticosteroid injections are also one of the other non-surgical treatments which are administered directly to the epidural space in the spine. These injections mainly reduce inflammation which ultimately provides pain relief.
According to Dr. Chou and colleagues, there are two conditions for which these injections are mainly used; radiculopathy (inflammation of a spinal nerve) and spinal stenosis (narrowing of the spinal canal).
People are getting inclined towards the use of epidural corticosteroid injections while its effectiveness in treating low back pain is still a big question in various studies.
No effect on spinal stenosis with epidural corticosteroid injections
In this study, 30 trials were reviewed by the team for evaluating the short and long term effects of epidural corticosteroid injections in individuals with radiculopathy or spinal stenosis in comparison with placebo. The patients were evaluated mainly for pain, function and risk for surgery. Greater immediate pain relief for radiculopathy was achieved with injections than placebo but the effect was too small and short term and also did not prevent the need of surgery as long term impact.
No significant pain relief for spinal stenosis with epidural corticosteroid injections as compared to placebo.
According to the authors, these findings are independent of the technique and type of corticosteroid used.
Dr. Chou told Medical News Today that study findings were not impacted by any of the factors like injection technique (transforaminal, interlaminar, caudal), type or dose of corticosteroid, selection of patients with imaging guidance, and other patient and technical factors. The results were same no matter how the data was sliced. Severe side effects were rare while some minor side effects included bleeding, blood clots and nerve root irritation.
Dr. Chou explained the reason for the infectiveness of epidural corticosteroid injections in radiculopathy and spinal stenosis. He said that corticosteroids usually reduce inflammation and related swelling but inflammation may not be the important factor in most patients. There are chances that pain improves over time with or without treatment and we know that low back pain treatments have strong placebo effect, so that could be what we're focusing.
Patients should know alternative treatment options
Dr. Chou told MNT that it is important for the patients to know alternative treatment options for radiculopathy and spinal stenosis. Dr. Zack McCormick, Northwestern University Feinberg School of Medicine, Chicago, IL, told Reuters that the trials analyzed in this research were of low quality, so the findings cannot be applied to realistic day-to-day practice of spine medicine.
However, he believes that the aim of epidural corticosteroid injections is to improve short-term symptoms and quality of life for the patient and not to provide a long-term cure but the treatment should not be used as an isolated therapy.
Also, a study published earlier this year in The BMJ, found acetaminophen ineffective for lower back pain and osteoarthritis.