Steroid injections widely used to treat back pain offer little or no real benefit, according to a new study of 400 patients published in the New England Journal of Medicine and summarized by an article by Reuters Health.
Those who received the drug mixed with the painkiller lidocaine scored no better on measures of disability and leg pain after six weeks than patients in a control group who received lidocaine injection alone. “These (injections) are so commonly used and the steroids do pose an added risk to patients without much benefit,” the study’s lead author Dr. Janna Friedly of the University of Washington in Seattle told Reuters Health. “I do hope patients and their doctors will be more cautious about using them” for spinal stenosis, she said.
Lumbar spinal stenosis is a narrowing of the passageway surrounding spinal nerves in the lower back. The resulting nerve compression is painful and the number one reason older adults have spinal surgery. The combination of glucocorticoid steroids and an anesthetic is supposed to reduce nerve inflammation and swelling in the surrounding tissue. Roughly 550,000 procedures – at a cost ranging from $500 to $2,000 per injection – are done each year just among Medicare recipients.
“Certainly, this study raises serious questions about the benefits of epidural glucocorticoid injections for spinal stenosis,” Dr. Gunnar Andersson of Rush University Medical Center in Chicago writes in an accompanying editorial in the New England Journal of Medicine. “It’s looking like it may be a little harder to justify doing those injections for spinal stenosis in patients. But it doesn’t show it’s not effective at all,” said Dr. D. Scott Kreiner, co-chairman of the guidelines committee of the North American Spine Society, who was not involved in the research.
In the editorial, Andersson said if patients decide to have injections anyway, a second one should be avoided if there is no effect from the first. Because many insurance companies require the injections before surgery is approved, the new finding, combined with the U.S. Food and Drug Administration’s warning that they can cause paralysis, nerve damage or death, “suggest that this requirement should be reconsidered,” he said.
Friedly predicted that the findings will meet with some resistance among doctors because “these are injections that are commonly performed and people believe that they work,” which is why the results were surprising. “There are not a lot of effective treatments for pain and symptoms associated with spinal stenosis,” she said. “We still have a lot of unanswered questions about what alternative treatments are effective.”