Steroid injections for chronic back pain found ineffective

Epidural Steroid Injections (ESI) have been the gold standard of non-surgical care for various forms of low back pain and sciatica since 1952. The group of pain conditions affecting the back, hip and outer side of the leg is known as sciatica, and is caused by the compression of the spinal nerve root in the back, known as spinal stenosis, usually due to the degeneration of an intervertebral disk.

The goal of ESIs is to manage the pain resulting from sciatica and lower back pain, and has been shown to provide temporary relief in cases of acute back/leg pain. The most efficient use of the ESIs are to enable patients to push through the pain of rehabilitation that often accompanies ESIs as part of sciatica treatment. The efficacy of the ESIs has long been in question, however, due to the lack of comprehensive studies that profile its long-term efficacy.

A new study published on July 3 in the New England Journal of Medicine by Dr. Janna Friedly, assistant professor of rehabilitation medicine at the University of Washington in Seattle, has shed considerable light on the issue. The study aimed to find out if the pain levels and physical limitations experienced by spinal stenosis patients receiving ESIs were significantly different than those receiving a simple local anaesthetic, lidocaine, in this case. 

The study was conducted by randomly assigning 400 participants with spinal stenosis either lidocaine or a combination of local anaesthetic with ESIs. Participants were then asked to rate their pain on a scale of 0-10 three weeks and six weeks after receiving the injection. Additionally, they were asked to rate their physical limitations based on the Roland-Morris Disability Questionnaire scale of 0-24.

The results of the study showed an initial spike reporting less pain and physical limitation after three weeks from the ESI group compared to the lidocaine-only group. Interestingly enough, however, after six weeks, there was no significant difference reported between the two groups.

Researchers also asked participants to comment on their satisfaction with treatment. Results showed that 67 percent of the ESI group were “somewhat” to “very” satisfied, compared to the 54 percent of the lidocaine-only group. Researchers attributed the increased satisfaction to the initial pain relief experienced by the ESI group.

The study additionally found that there was a higher incidence of adverse effects in the ESI group, including fever and/or infection, due to the steroids. This revelation will be significant in deciding how physicians decide to treat spinal stenosis and sciatica here on out.

“If patients are considering an epidural injection, they should talk to their doctor about a lidocaine-only injection, given that corticosteroids do pose risks and this study found that they provided no significant added benefit at six weeks,” said Dr. Friedly.

Alternative treatments include chiropractic/manual manipulation of spinal column alignment, acupuncture, and massage therapy.

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