Public health

No point to steroid injections for low back pain

Wednesday, 29 Mar 2017

Steroid injections provide only short term relief for people with chronic low back pain, a French study confirms.

The study of 135 participants with chronic low back pain and Modic type 1 lesions found more than half of the patients (55%) who received an image guided intradiscal glucocorticoid injection had pain intensity below the threshold of 40 (on a 0-100 scale) after one month.

However the gain was only short-term with pain increasing after three months and higher than in the control group. There was no significant difference in pain intensity at 12 months.

Other outcomes including NSAIDs and analgesics use, the Hospital Anxiety and Depression Scale and the Quebec Back Pain Disability Scale were no different between the treated and control groups.

“Our results do not support the wide use of an injection of glucocorticoid in alleviating symptoms in the long term in this condition,” concluded the researchers in their paper published in the Annals of Internal Medicine. 

Commenting on the study, Professor Chris Maher from the George Institute for Global Health told the limbic there were many effective non-invasive treatments for low back pain.

“These authors were operating in a manner, contrary to contemporary guidelines, believing that they can identify the anatomical source of the pain and fix the problem with targeted therapy. Both beliefs are completely wrong. There is a whole series of trials showing this targeted approach does not work.”

“In the short term there was a small benefit but over time the treatment appeared harmful as it led to greater pain. Previous trials of these injections for tennis elbow have shown the same pattern,” Professor Maher said.

He said patients with chronic back pain were also being inappropriately treated with injections of stem cells and autologous blood products.

“What they all have in common is that they cost a lot of money and have not been shown to work in properly conducted trials.”

An accompanying editorial  to the paper applauded the researchers for using inclusion criteria that reduced the heterogeneity of disease in their study group.

However steroid injections may not be able to address the non-inflammatory contributors to chronic pain, the editorial said.

“In some patients, chronic low back pain is not due solely to a musculoskeletal pathology.”

“A large volume of research shows that depression, psychological distress, passive coping strategies, fear-avoidance beliefs, perceived risks of persistent low back pain, and even low educational level are linked with poor outcomes in patients presenting with low back pain.”

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