Do Epidural Steroid Injections Help Lower Back Pain?

Do Epidural Steroid Injections Help Lower Back Pain?

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.”

Authored by: Ed Coghlan

There are 6 comments for this article
  1. Bob Haley at 9:53 am

    Run from these things! They don’t work and your insurance company will deny you coverage a majority of the time. But they don’t send the denial letter until a week or so after you have the procedure. So you pay out of pocket…a lot out of pocket.

  2. ginbug at 6:56 pm

    I went to a pain doc for severe hip & knee pain & ended up getting 8 epidural shots. While I did have some back pain, it would just be in flares. However after these shots, my back does NOT stop hurting & the pain is 1000% worse, plus I got the added benefit of severe migraines! I had the 1st migraine ever in my life, the day after the 1st epidural & thought I was dying as it lasted all day & night! My doc claimed that w/ some people, the pain would get worse after the 1st one; & that more than 1 was required to give me relief.
    So I got the second 4 shots, however the migraine hit me before I could even get home & lasted 3 days!! He wanted to do another one, but I refused & was told that unless I follow his complete treatment, he could not give me my pain meds!!
    These “hostage” docs should loose their license as they have too much control over our bodies!

    All you hear about is how the “bad” docs are over using opioids; but NO ONE say ANYTHING about the HUGE over use of a procedure that is not fda approved & causes horrific damage that hurts FAR more than the teeny tiny it helps! Why are they allowed to lie, mislead, take advantage of, severely damage pain patients, & be viewed as the “good” pain docs, just because they refuse pain meds as an option?

    While there needs to be caution used by doc & patients before they decide to treat w/ opioids; it should still be a considered option! All I ask is to be told the absolute truth, risks vs. benefits of ALL treatment options & allow ME to decide what risks I am willing to take for MY OWN BODY!!! There are MUCH WORSE things than becoming DEPENDENT on pain meds!!!!

  3. Brenda Flippen at 10:19 pm

    I cannot remember how many of these injections I have had. 30 maybe. And it has depended on who did them. I have had them last from 9 months or only 2 months. I have also had some do nothing but make me sore, in my back and my bank account. Only one doctor has ever done the procedure that worked. Was it a fluke or power of suggestion? I can promise you it was real. Btw, I have had 2 low back surgeries and 1 neck. And I still had to have the blocks. I also believe the key to any the treatments to helping back problems is being able to exercise and stretch. You have to work at it. Physical Therapy is a given. Not easy at first but well worth the effort.

  4. Kerry Smith at 7:11 pm

    I have had more of these injections than I care to think about and most of them did not work. Maybe for a day or so but then the pain came back. It used to be, and I am not sure if it is still the case, that insurance companies required them as a part of doing the conservative treatment avenues before surgery. I think only a couple have worked out of the 7 or 8 I have had. Amazingly, my neurosurgeon will ask me to have some of these injections done along my hardware in my lumbar fusion to determine if indeed my hardware is giving me pain. But overall, no they have not worked.

  5. Robert R. Cuminale at 3:00 pm

    I wouldn’t recommend because of a bad experience.
    Wishing to avoid surgery for a blown disc I agreed to a shot. The nerves had been severely affected and I was unable to flatten my foot and had to walk on my toes.
    as the shot was going in I remarked to the doctor that it felt like cold water was running down my leg. He said nothing. This was on Tuesday.
    That afternoon I was in at least twice the pain in my back and leg and my foot wouldn’t move. Icalled the surgeon’s office and he and his partner were out of town. The PA said that the pain wasn’t going to go away immediately after the shot and to continue with the Lortabs. This in spite of my complaint that it was much worse. This continued on through Friday with no relief. I called every day and got the same response.
    I stopped in at my GP and he gave me a Demerol shot which lasted all of 3 hours. I was awake all night lying on the floor. The pain passed through me in waves and involved my entire body as I clamped down to try to stop it.
    At 5AM my wife took me to the emergency room. I was put on an IV and four pain relievers and muscle relaxants were pumped in. I went to sleep around 7AM. At 8:30AM I woke up. The wife said that they’d had to repeat the four drugs while I was sleeping.
    I fired the surgeon and got a new one. After the surgery he apologized for the large hole he’d made but said that every time he reached there were more pieces of the casing around the disc in the nerve bundle and he’d had to cut a longer and deeper hole to reach them. I asked if that could be from the shot but he wouldn’t commit to that.
    These shots can do more damage and I don’t think I would ever allow someone to give me one again. I lost 90% of nerve conductivity in that leg and I am in constant pain.

  6. Idalia Garcia at 2:48 pm

    I had an epidural right below the base of my neck for a bone spur and narrowing and I was pain free for a year and a half or so and now there are days I am back to square one with the pain..there are days I can’t even touch that spot but I had another injection on my hip and that didn’t last very long…months maybe…Question?? Is it true that these injections may make your bones brittle?…..2 doctors told me this and told me to not do any injections