Can injection therapy help low back pain sufferers?

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Most adults will suffer from low back pain at some point in their lives. It is the fifth most common reason for primary care office visits and medical expenditures for low back pain have been increasing since 1997. Spinal injection therapy is one treatment option for low back pain, but recent studies indicate that there is not enough conclusive evidence to warrant recommending injection therapy for low back pain patients.

There has been a lot of variation in injection therapy in terms of where the injection is administered and what pharmaceutical agent is used and in what dosage. A 2009 Cochrane Collaboration systematic review used 18 randomized controlled trials that had looked at the effects of injections on subacute back pain back pain lasting between four and 12 weeks and chronic back pain. However, variations in the methods used for injections varied too widely across trials to allow statistical calculations to be made. Additionally, the majority of the studies did not show significant results for the outcomes being used (pain, disability or generic health status).

A meta-analysis including 23 placebo-controlled trials was conducted more recently looking at epidural steroid injections in patients with sciatica. Although a small effect was found for short-term treatment of leg pain, over the long-term, results became insignificant.

Currently, guidelines for low back pain do not include injection therapy. Instead, recommendations include brief education about low back pain, back schools (ie school-based education and skills programs, including exercises, supervised by a paramedical therapist or medical specialist), NSAIDs, opioid analgesics, back exercises, spinal manipulative therapy, multidisciplinary rehabilitation, and behavioral therapy. Unless more conclusive research can point to a clear benefit of injection therapy, it cannot be considered clinically beneficial.

ACSH S Dr. Gilbert Ross had this perspective: When I was in practice as a rheumatologist, I saw many patients with low-back pain. Some were in acute misery and could barely move, while others had chronic or recurrent complaints. While rarely was surgery indicated, often the combination of laying on of hands, a judicious regimen of pain relievers and a local injection of cortisone and novocaine worked wonders. Or so I thought. This study, a meta-analysis actually, seems to show the injection part was more likely a placebo effect rather than effective therapy. But, if done carefully, the downside is very small, and I did not shirk from applying the placebo effect if it helped, or seemed to!