Low Back Pain: Steroid Injections Do Not Provide Long-term Relief

While a common method used to treat low back pain may provide immediate relief, its effects do not extend for a substantial period of time, a new analysis has found.

For some back pain conditions, surgery may seem like the inevitable endpoint. Epidural corticosteroid injections and prescription drugs are often used to alleviate pain and reduce the need for surgical intervention. A team of researchers reevaluated the efficacy of the injections in patients with radiculopathy and spinal stenosis, as documented in Annals of Internal Medicine.

“Epidural corticosteroid injections are perceived as being more effective than they are,” first author Roger Chou, MD, from Oregon Health & Science University, wrote in an email to Reuters Health.

The team analyzed data gathered from Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, prior systematic reviews, and reference lists. They evaluated the effects of epidural corticosteroid injections versus placebos in adult patients — 30 trials for radiculopathy and eight for spinal stenosis.

The radiculopathy-focused studies revealed that the injections provided more immediate relief in pain — an average decrease of 7.55 on a scale of 0 to 100. In addition, quick improvement was observed in function and short-term surgery risk.

“However, benefits were small and not sustained, and there was no effect on long-term surgery risk,” the authors confirmed.

Furthermore, there were not any positive or negative effects in the patients with low to moderate spinal stenosis. However, the authors noted that some of the studies, especially for spinal stenosis, were based on small cohorts.

“I think the important thing is for patients and clinicians to be able to make informed decisions,” Chou continued in the email. “Unfortunately, there are not a lot of great treatments for these conditions besides surgery so the options for treatment are limited.”

Radiculopathy and spinal stenosis are not conditions with quick fixes for long-term benefit. Chou concluded that improvement is usually experienced over a period of time — which is something to keep in mind about the injections and other treatments.