Every year millions of patients are injected with epidural steroids to treat back pain, but now, new research suggests that many of those injections are completely unnecessary. In a study released Wednesday from The New England Journal of Medicine, researchers found that epidural steroid injections failed to produce any measurable benefits compared to lidocaine injections for spinal stenosis.
This isn’t the first study to question the effectiveness of epidural steroid injections for back pain. What makes this research unique is that it is the largest randomized trial conducted yet on the effects of the injections for spinal stenosis. This condition refers to a narrowing of the spine that causes sciatica as well as pain in the back and legs.
The study included 400 patients with spinal stenosis who received injections of either steroids or an anesthetic (lidocaine). After six weeks, both groups showed similar rates of improvements, leading researchers to conclude that steroid injections “offered minimal or no short-term benefit.”
The FDA has not approved these injections for the treatment of back pain, yet doctors routinely perform the procedure in everyday practice. Why? Because some patients report improvements and many insurance companies require patients to get the injections prior to receiving surgery.
One orthopedic surgeon at Rush University Medical Center in Chicago, Dr. Gunnar Andersson told The New York Times, “It’s sort of become the thing you do. You see this abnormality on the M.R.I. and the patient complains, and immediately you send the patient for an epidural injection.” Dr. Andersson said the latest study will likely cause more physicians and patients to ask, “Should I really do this?’”
In answering that question, patients should consider the risks. Although the injections are generally considered safe, the FDA warned in April that in rare cases the treatment may cause blindness, stroke, paralysis, and even death. In 2012, contaminated steroid injections were linked to an outbreak of fungal meningitis with 751 cases, including 64 deaths. Many of those infected had received the injections for spinal stenosis and back pain.
The treatment also carry additional risks for the elderly: A study of patients over 50 years old found that every new injection of epidural steroids resulted in a 21% increase in a patient’s risk of vertebral fractures.
For seniors who don’t want to take those chances (however rare), chiropractic care can alleviate symptoms of spinal stenosis in many patients, research suggests. In fact, when it comes to disc herniation, one trial found that chiropractic was just as effective as epidural steroid injections in easing back pain, but without the costs or risks.