Epidural Steroid Injections in the Back: Minimal Help

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 About 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 went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. 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 Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. 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.

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