According to the National Institute of Neurological Disorders and Stroke, approximately 80% of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days. Many low back pain sufferers turn to epidural corticosteroid injections for relief; however, a large new study reports that the benefits are only short-term, ant the long term benefits are miniscule. The findings were published online on August 25 in the Annals of Internal Medicine.
The researchers conducted a meta-analysis, which is a review of a number of appropriate studies to clarify a point. The aim of the study was to review evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration. Radicular low back pain, or radiculopathy is characterized by pain in the lower back and along the sciatic nerve, extending to the back of the thigh, and sometimes down the calf and foot. The condition is often the result of a herniated disk. Spinal stenosis tends to be more degenerative than radiculopathy, and it is caused by a narrowing of the open spaces within the spine, which puts pressure on the spinal cord and the nerves in the spine, arms and legs. Both conditions are characterized by inflammation and pain, which can be relieved by corticosteroids, which have anti-inflammatory properties.
is pain that radiates along the dermatome (sensory nerve originating from the spine) of a nerve due to inflammation or other irritation of the nerve root at its connection to the spinal column. Spinal stenosis is a narrowing of the passage where the spinal cord runs.
A total of 30 placebo-controlled clinical trials that evaluated epidural corticosteroid injections for radiculopathy were reviewed. In addition, 8 trials were reviewed that investigated the treatment for spinal stenosis. For radiculopathy, compared to a placebo (e.g., saline injection) epidural corticosteroids were found to provide greater immediate-term reduction in pain, function, and short-term surgery risk, However, the injections provided no long-term benefits. The investigators found were no clear benefits of epidural corticosteroid injections for spinal stenosis; however, harms reporting was limited.
The authors concluded that epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, the benefits were small and not sustained over time. In addition, there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness of epidural corticosteroid injections for spinal stenosis.
The authors are affiliated with: Pacific Northwest Evidence-based Practice Center, and Oregon Health & Science University, Portland, Oregon; Spectrum Research, Tacoma, Washington; and Comparative Effectiveness, Cost and Outcomes Research Center and University of Washington, Seattle, Washington.