Steroid Injections Offer Little Relief For Low Back Pain

Epidural corticosteroid injections (ECI) were ineffective in the long-term for relief of pain with radiculopathy, and offered no clear benefits for patients with spinal stenosis, according to a recent meta-analysis.

The utilization of ECI for patients with low back pain is becoming more common. In order to review the safety and effectiveness of the practice, researchers conducted a meta-analysis of 38 trials (30 placebo-controlled trials involving patients with radiculopathy and 8 trials of those with spinal stenosis).
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Overall, ECI were associated with immediate but short-term relief of pain, prevention of surgery, and improvement in function for patients with radiculopathy, but the benefits did not remain beyond 2 weeks of follow-up.

Further, the short-term effects all fell beneath predetermined minimum clinically important difference thresholds. (15 points on a 100 point scale of pain, 10 points on the Oswestry Low Back Pain Disability Index, and 5 points on the Roland-Morris Disability Questionnaire).

In patients with spinal stenosis, researchers found that ECI performed no better than placebo. These results remained after controlling for injection technique, use of imaging guidance, and other factors.

The study was published in Annals of Internal Medicine.

—Michael Potts

Reference:

Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med. 2015;163(5):373-381.