Effectiveness of Back Pain Steroids Questioned

Steroids may not be the key ingredient behind back pain relief from epidural steroid injections. A new literature review from John Hopkins found that steroids were no more effective than injections of any number of fluids, including anesthetics and saline, for low-back pain.

Epidural steroids injections have long been used in the medical treatment of low-back pain, despite extensive research showing mixed results. Some studies have found that only 60% of patients experienced relief from the injections, and it is still unclear whether there are any long-term benefits. At the same time, epidural steroid injections have been found to increase the risk of spinal fractures in the elderly and are considered unsafe for those recovering from spinal cord injuries. Steroids may also increase blood sugar in patients with diabetes, inhibit wound healing after surgery, and may even accelerate bone disease. Public concerns over epidural steroid injections spiked last year after an outbreak of fungal meningitis tied to contaminated steroid inflicted more than 740 people in 20 states and caused 55 deaths.

To clarify the effects of epidural injections amid the controversy, Steven P. Cohen, MD, and his colleagues from John Hopkins Medicine, recently conducted a literature review of the research on lumbar epidural steroid injections. The meta analysis included 3,641 participants in 43 studies comparing the effects epidural steroid injections to a number of other injections.

Cohen and his colleagues found that epidural steroid injections were twice as likely to bring pain relief than saline, injections of anesthetics like Lidocaine, and steroid injections. However, they also found that all types of epidural injections were twice as helpful as intramuscular injections of steroids. They concluded that simply injecting any liquid into the epidural space appeared to work, which suggests that the effects epidural steroid injections may not arise from the steroids themselves.

"In light of these findings, opportunities exist for clinicians and investigators to modify their approach to these procedures, such as reducing or even in some cases eliminating, the steroid component of epidural injections in high-risk scenarios," the authors wrote.

Patients searching for long-term relief of back pain without the potential side effects and risks of drugs could consider chiropractic care. Research has demonstrated that chiropractic is as effective as epidural steroid injections for relieving pain from lumbar disc herniation, only without the potential risks.


Bicket M, et al. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the "control" injections in randomized controlled trials. Anesthesiology 2013; 119 (4) 907-931.

Medicine, Johns Hopkins. Analysis suggests saline shots may do just as well as steroids for lower back pain. Medical News Today. MediLexicon, Intl., 19 Sep. 2013. Web.
14 Oct. 2013.

Peterson, CK, et al. Symptomatic Magnetic Resonance Imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. Journal of Manipulative and Physiological Therapeutics 2013; doi: 10.1016/j.jmpt.2013.04.005.