Do Steroid Injections ease low back pain?
Spinal pain is a leading cause of disability with lifetime incidence estimated to between 50-80%. In the vast majority of cases surgery is not indicated, however in those cases where back pain has become debilitating, epidural injection has been a standard treatment option for over 50 years.
Benefits of epidural steroid injections are unclear with studies commonly showing benefits in patients only 60% of the time. In addition to this, some authors highlight concerns over potential side effects such as raised blood sugars in diabetics and acceleration of osteoporosis in older women.
In a review of the literature the authors below found patients were twice as likely to gain pain relief from epidural steroid injections compared to intramuscular injections. Perhaps more surprisingly, it didn’t appear to matter what was injected into the epidural space, steroid, saline or local anaesthetic.
This does go someway to explaining why studies may often find no significant difference comparing the benefit of steroid epidural with saline placebo epidural!
It may also mean the dosages of steroid could be reduced thereby alleviating many of the worries associated with steroid usage.
As always the authors conclude by saying more studies will be needed….
Mark C. Bicket, Anita Gupta, Charlie H. Brown, Steven P. Cohen. Epidural Injections for Spinal Pain. Anesthesiology, 2013; 119 (4): 907