A recent study concluded what many other studies have: that epidural steroid injections in the back provide minimal relief, often no more than placebo. They looked at two types of patients – those
Steroid injections are the economic engine of many “pain” centers in the United States, for which they charge a fair bit of money. Many “pain centers” do not contract with insurance companies, and thus find patients who either pay cash or who have insurance that have “out of network” benefits.
From the study that looked at over 30 placebo controlled trials:
Conclusion: Epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis.
Steroid injections go along with other treatments that do not offer much to back pain which include:
- Chiropractic – no more effective than physical therapy, and no evidence “back cracking” works at all
- Acupuncture – no good study shows these help with chronic back pain
- Oral Steroids – steroid pills for back pain don’t work
- Gabapentin – commonly prescribed drug but not FDA approved for back pain
Multiple medications such as Gabapentin, lyrics are often prescribed for back pain, and rarely work. Probably in the nature of placebo range.
What does work:
- Resting the back
- Physical therapy
- Operations when an anatomical issue is discovered
Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 25 August 2015] doi:10.7326/M15-0934
Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1748 (Published 16 April 2015)
Cite this as: BMJ 2015;350:h1748
Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, then became a renowned weight loss surgeon, and a leading advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he advocates teaching people to improve their health through their food. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcom Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.