Corticosteroid Injections In Back Pain

 Corticosteroid injections may be ineffective for low back pain

 

 

Low back pain is the leading cause of disability worldwide. In the US, around half of all workers admit to experiencing symptoms of back pain each year, and approximately 80% of us will suffer a back problem at some point in our lives.

Primary treatment for low back pain involves nonsurgical options, such as narcotic pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs). Other nonsurgical treatments include epidural corticosteroid injections, administered directly to the epidural space in the spine.

Epidural corticosteroid injections work by reducing inflammation and, in turn, relieving pain. According to Dr. Chou and colleagues, the injections are commonly used for radiculopathy (inflammation of a spinal nerve) and spinal stenosis (narrowing of the spinal canal) - two conditions that cause radiating low back pain.

Use of epidural corticosteroid injections for these conditions is increasing, despite the fact that numerous studies have questioned their effectiveness for low back pain.

Epidural corticosteroid injections 'perceived as more effective than they actually are'

 For their study, the team reviewed 30 trials assessing the short- and long-term effects of epidural corticosteroid injections for individuals with radiculopathy or spinal stenosis, comparing them with a placebo.

Specifically, the researchers looked at how epidural corticosteroid injections impacted patients' pain, function and risk for surgery.



While the injections provided greater immediate pain relief for radiculopathy than a placebo, the team found that this effect was small and short term. What is more, the treatment did not prevent patients' need for surgery in the long term.

For spinal stenosis, the researchers found epidural corticosteroid injections offered patients no significant pain relief compared with placebo.

These findings remained regardless of what injection techniques and corticosteroids were used, according to the authors.

While severe side effects from corticosteroid injections were rare, some minor side effects were identified, which included bleeding, blood clots and nerve root irritation.

Talking to Reuters, Dr. Chou said epidural corticosteroid injections are being perceived as much more effective for low back pain than they actually are.

"Unfortunately, there are not a lot of great treatments for these conditions besides surgery, so the options for treatment are limited," he added. "I do let patients know that the natural history for both of these conditions is for improvement over time."

However, the results of this study have been met with some criticism. Dr. Zack McCormick, of the Northwestern University Feinberg School of Medicine in Chicago, IL, told Reuters that the trials analyzed in this research were of low quality, so the findings "cannot be applied to the realistic day-to-day practice of spine medicine."

He noted, however, that the aim of epidural corticosteroid injections is to improve short-term symptoms and quality of life for the patient, not to provide a long-term cure. As such, he says the treatment should "not be used as an isolated therapy."

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Back Pain

Back pain is a common problem that affects most people at some point in their life.

It may be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. It’s not generally caused by a serious condition. Find out more about the causes of back pain.

In most cases, back pain will improve in a few weeks or months, although some people experience long-term pain or pain that keeps coming back.

Types of back pain

Backache is most common in the lower back ('lumbago'), although it can be felt anywhere along your spine, from your neck down to your hips. Read information on neck pain and shoulder pain, which are covered separately.

Sometimes, back pain can be caused by an injury or disease, such as:

•     a slipped disc – when one of the discs in the spine is damaged and presses on the nerves

•     sciatica – irritation or compression of the sciatic nerve, which causes pain, numbness and tingling that travels down one leg

•     whiplash – neck injury caused by a sudden impact

•     frozen shoulder – inflammation around the shoulder that causes pain and stiffness

•     ankylosing spondylitis – a long-term condition that causes pain and stiffness where the spine meets the pelvis

The rest of this information will focus on back pain that doesn’t have an obvious cause. Doctors call this “non-specific back pain”.
What to do

Most cases of back pain get better on their own and you may not need to see a doctor.

If you’ve only had back pain for a few days or weeks, the following advice may help relieve your symptoms and speed up your recovery:

•     remain as active as possible and try to continue with your daily activities

•     take over-the-counter painkillers, such as paracetamol or ibuprofen if you feel you need to

•     use hot or cold compression packs – you can buy these from your local pharmacy, or a bag of frozen vegetables and a hot water bottle will work just as well

Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive because this can help you recover faster.

Treatments for long-term back pain

If you’re worried about your back or your pain hasn’t improved by around six weeks, it’s a good idea to visit your GP, who can advise you about the treatments available.

These include:

•     stronger painkillers

•     exercise classes – where you are taught specific exercises to strengthen your muscles and improve your posture

•     manual therapy, such as physiotherapy, chiropractic or osteopathy

•     acupuncture

•     counselling, such as cognitive behavioural therapy (CBT)

•     support and advice at a specialist pain clinic

Some people choose to see a therapist for manual therapy or acupuncture without seeing their GP first. If you want to do this you will usually need to pay for private treatment, which is likely to cost around £30-50 for each appointment.

Spinal surgery is usually only recommended when all else has failed.


Source : http://www.nhs.uk/conditions/Back-pain/Pages/Introduction.aspx

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