Epidural steroid injections relieve pain, but only momentarily: study

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As much as $50 billion is spent each year for back pain in America, and 31 million Americans experience low-back pain at any given time. The American Chiropractic Association (ACA) also reports that according to the Global Burden of Disease 2010, low-back pain is the single leading cause of disability worldwide. There are several causes for back pain, including sprained ligaments, strained muscles, ruptured disks and irate joints. However, the ACA reports that "most cases of back pain are mechanical or non-organic, meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer."

Reuters Health reports that a new study found that spinal epidural injections of steroids can provide relief from back pain, but only temporarily. Epidural steroid injection or ESI, according to the Mayfield Clinic, is "a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation."

The new study shows that spinal epidural injection of steroids don't provide significant relief for pain related to the narrowing of spaces around the spinal cord.

Dr. Roger Chou of the Oregon Health & Science University in Portland and his colleagues studied 63 published reports on epidural steroid injections for treatment of low back pain caused by ruptured discs or spinal narrowing. The study showed that the injections provided relief for those suffering from back pain due to ruptured disks, but not for those who had spinal narrowing. The study also showed that injecting steroids did not provide stellar results compared to using placebo. Additionally, there wasn't any decrease in the need for surgery.

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

Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, stated: "The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy."

He added that "epidural steroid injections should not be used as an isolated therapy. More studies are needed which show outcomes of epidural steroid injections in conjunction with a multi-modal approach that includes physical therapy, oral medications, and other adjunctive treatments, as this represents true clinical practice."

McCormick believes that the study provided conclusions that "cannot be applied to the realistic day-to-day practice of spine medicine" and that more studies needed to be done.

"Over a million people receive epidural injections either with steroids or with local anesthetic alone per year and at least 60% of them receive significant relief," said Dr. Laxmaiah Manchikanti from the University of Louisville, Kentucky. 

Nonetheless, the study provides more information for patients and their health options. Medical Daily reports that according to Chou, "The important thing is for patients and clinicians to be able to make informed decisions. Epidural corticosteroid injections are perceived as being more effective than they are."