How Much Do Spinal Steroid Injections Ease Low Back Pain?

Spinal epidural injections of steroids may relieve low back pain from a ruptured disc, but only briefly, a new study shows and the injections offer no significant relief for pain related to narrowing of the spaces around the spinal cord, the researchers say.

Some earlier studies have reached similar conclusions, but others have shown some benefit. Meanwhile, the use of epidural steroid injections has been increasing in the face of contradictory guidelines for physicians.

To clarify this confusing situation, Dr. Roger Chou from Oregon Health & Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing.

“I think the important thing is for patients and clinicians to be able to make informed decisions,” Chou told Reuters Health by email. “Epidural corticosteroid injections are perceived as being more effective than they are.”

Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine.

The new analysis seems unlikely to settle any controversies, however.

Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions “cannot be applied to the realistic day-to-day practice of spine medicine.”

“The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy,” McCormick said.

“Epidural steroid injections should not be used as an isolated therapy,” he added. “More studies are needed which show outcomes of epidural steroid injections in conjunction with a multi-modal approach that includes physical therapy, oral medications, and other adjunctive treatments, as this represents true clinical practice.”

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