A new study suggests steroid injections, commonly used to relieve back pain, offer little benefit to people suffering from lumbar spinal stenosis.
Lumbar spinal stenosis is a common cause of low back and leg pain due to arthritis. This condition often occurs in people aged 60 years old and above, mostly men. Symptoms begin as early as 30 years old. One of the nonsurgical treatments includes corticosteroid injections of not more than thrice a year. Medicare reported about 2.2 million lumbar epidural steroid injections performed yearly; the rate tripled compared to 20 years ago.
Dr Janna Friedly, lead author of the study and assistant professor in the department of rehabilitation medicine at the University of Washington, and her colleagues conducted a study in 16 hospitals involving 400 patients aged 50 and above to test the efficacy of steroid injections in relieving back pain. Half of the participants received cortisone injections with lidocaine, while the other half received lidocaine alone for six weeks.
The researchers then administered a satisfaction survey to measure whether participants experienced improvement with back pain. About 67 percent of those who received cortisone injections with lidocaine said they were very satisfied with the results - that rate was 13 percent higher than those who received lidocaine alone. However, the first group also reported more adverse side effects such as fever and infection at five percent compared to two percent of the second group.
During the first three weeks, the lidocaine-only group average pain improved by 2.6 percent and 3.6 percent in the sixth week. The cortisone injections with the lidocaine group, on the other hand, reported better pain relief on the first three weeks at 4.4 percent but showed less improvement on the sixth week at 4.5 percent only. Analysts considered the numbers either statistically insignificant or no difference at all.
To sum up all observations, the pain relief provided by steroid injections do not compensate the risks that come along with it. Researchers suggested doctors should inform patients about this and provide more options.
"This is the first large, multicenter randomized trial to look at epidural steroid injections for spinal stenosis, and we found that injection with corticosteroids and lidocaine provided these patients with minimal or no additional benefit over lidocaine injections," Dr. Friedly stated. "If patients are considering an epidural injection, they should talk to their doctor about the benefits and risks of the options available."
The results of this study were published in the July 3 issue of the New England of Journal of Medicine.