For many patients with back pain, epidural steroid injections do more harm than good, according to a new study by researchers with Thomas Jefferson University, Philadelphia.
The research, published in the medical journal Spine, found patients with spinal stenosis who undergo injections fare more poorly than those who don’t have them — regardless of whether they later have back surgery.
Lead researcher Kris E. Radcliff, M.D., said the findings raise serious questions about the benefits of the widely used treatment for the common problem of lower back pain.
"Despite the common treatment practice of incorporating one or more [injections] in the initial non-operative management of patients with spinal stenosis, these results suggest that [they are] associated with worse outcome in the treatment of spinal stenosis," Dr. Radcliff and colleagues concluded.
Spinal stenosis is narrowing of the spinal column that causes painful pressure on the spinal cord or narrowing of the openings where spinal nerves leave the spinal column.
For the study, the researchers analyzed data from the Spine Outcomes Research Trial — one of the largest clinical trials of surgery for spinal disorders — and compared the experiences of 69 patients who underwent steroid injection and another 207 who did not.
The results showed the patients who had the injections had “significantly less improvement” overall than untreated individuals. What’s more, those who eventually had back surgery after getting injections showed less improvement in pain and physical functioning pain after four years than those who did not have the steroid treatment.
"There was no improvement in outcome with [steroid injections] whether patients were treated surgically or non-surgically," said Dr. Radcliff.
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