Monday, May 29, 2017

Steroid Injection Not Better Than Placebo For Low Back Pain

Picture by Army Medicine from Flickr
It seems like another of my patients has been asked if he wanted a cortisone (or corticosteroid) injection for his low back pain after I wrote about my shoulder pain patient last week who was asked by another doctor to get a steroid injection.

Evidence that they (cortisone or corticosteroid injections) work no better than placebo is mounting though.

The article referenced below is a systematic review. A systematic review is a computer aided search for all randomized and clinical controlled trials, meaning it's top of the line in terms of quality.

Researchers pooled data together from 30 placebo controlled studies of epidural steroid injections for radiculopathy (back pain that radiates to legs) and eight studies for spinal stenosis (back/ neck pain caused by narrowing of the spinal canal).

For radiculopathy, the steroid injections provided only short term relief. Over time, they were not more effective compared to placebo injections. They also did not reduce the need for surgery later for patients with more severe conditions.

The pooled data was similar for spinal stenosis.There was only some moderate temporary pain relief after the corticosteroid injections. There were no differences between steroid injections and placebo injections in pain intensity or functional ability lasting six weeks or longer after the injections.

The authors did note that some studies did not have many subjects while others had shortcomings their methodology.

The researcher in charge also suggested that there was probably some financial motivation to carry on using steroid injections despite the lack of evidence for its effectiveness. There is also a worry among professional societies (for doctors) due to implications for insurance coverage.

Other mentioned less selfish reasons is that doctors see their patients in horrible pain and concede that they do get some pain relief after the injections.

Please come to our clinics if you need help with your low back pain. We definitely do not give steroid injections.


Reference

Chou R, Friedly J et al (2015). Epidural Corticosteroid Injections For Radiculopathy And Spinal Stenosis: A Systematic Review And Meta-analysis. Ann Intern Med. 163(5): 373-381. DOI: 10.7326/M15-0934.

7 comments:

  1. I have gone through your blog. The information you have given are really informative.
    Regards
    https://www.kentmskclinic.co.uk/ultrasound-guided-spinal-injections/

    ReplyDelete
  2. Hello your content is sharing great information. Cortisone Injection providing best clinic in london,UK. Thanks for share this blog.
    Regards
    Cortisone Injection

    ReplyDelete
  3. This post is so useful and relevant. Too easy to understand. Thanks for your post. Keep blogging

    https://www.kentmskclinic.co.uk/

    ReplyDelete
  4. Hello your content is sharing great information. thanks...

    https://www.kentmskclinic.co.uk/ultrasound-guided-injections/

    ReplyDelete
  5. I feel like I need to re-read this article because I just really want to say “thank you",it was an amazing article, I will come back to read others.

    Regards,
    Spinal Injection

    ReplyDelete
  6. "I believe there are many more pleasurable opportunities ahead for individuals that looked at your site. Really it was a good blog, you have provided clear information. Nice Post. Keep write.
    "

    Regards,
    Spinal Injection

    ReplyDelete
  7. This post is so useful and relevant. Too easy to understand. Thanks for your post. Keep blogging

    Regards,
    Cortisone Injection

    ReplyDelete