A new study is highly critical of the effectiveness of epidural steroid injections for the relief of lower back pain.
A review published in the Annals of Internal Medicine has concluded these epidural injections only offer mild, temporary relief for those suffering from a herniated disc and is no better than a placebo for those with spinal stenosis, or a narrowing of the spinal column that often results in lingering pain.
Analyzing thirty placebo-controlled clinical trials that studied people suffering from herniated discs, the authors found that there was an immediate improvement in pain, patient function, and short-term surgery risk for those given steroid injections over a placebo.
However, these improvements were “small and not sustained, and there was no effect on long-term surgery risk.” In the eight trials involving spinal stenosis, the authors found no clear difference between a placebo and epidural injection among the patients studied. And their findings didn’t indicate that any particular type of steroid or injection site resulted in better long-term outcomes. While the risk of severe side-effects remained low, the authors found that the reporting of adverse effects in the studies was fairly poor.
“ESIs are high cost, low value health care,” said Terri Lewis, Ph.D, who is an expert of rehabilitation medicine and a frequent contributor to the National Pain Report.
A spokesman for the American Chiropractic Association went ever further.
“There are no surprises in this study,” said William Lauretti, DC, FICC who spent over 12 years in practice before joining the Chiropractic Clinical Science faculty at New York Chiropractic College.
“The cost of these injections versus the benefit and the accompanying risk don’t make sense for the patient,” he said.
Dr. Lauretti also said that the idea most back pain comes from a disc problem is a “myth”. He said that stiff joints and tight muscles are the most likely cause.
I think the important thing is for patients and clinicians to be able to make informed decisions,” lead author Dr. Roger Chou of Oregon Health & Science University told Reuters Health. “Epidural corticosteroid injections are perceived as being more effective than they are.”
Dr. Lewis added her thoughts to the efficacy question.
“As the authors of this meta-analysis note, when one accounts for all of the data and compares apples to apples, there is little evidence to recommend the use of this procedure to the majority of patients who present with chronic pain.”
She said that more than 9 million procedures are delivered annually to patients under outpatient conditions that escape regulatory scrutiny and safeguards.
“It is time for the development of a national pain strategy,” she said. “Patients should not be forced into ineffective protocols as an either/or condition for treatment.”