Key Points
International study warns against epidural steroid injections
Chronic back pain affects one in five adults worldwide
Procedures costly and offer minimal pain relief
Research analyzed 13 common interventional methods
A team of clinicians and patients from Canada, the US, and Australia strongly recommended against epidural steroid injections and nerve blocks for people living with chronic back pain (lasting at least three months) that is not associated with cancer, infection, or inflammatory arthritis.
Chronic back pain is the leading cause of disability worldwide -- estimated to affect one in five adults aged 20-59. Older adults tend to suffer more with the condition.
Epidural steroid injections, nerve blocks, and radiofrequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals from reaching the brain.
However, current guidelines provide conflicting recommendations for their use.
To probe, the team compared the benefits and harms of 13 common interventional procedures, or combinations of procedures, for chronic, non-cancer spine pain against sham procedures. These include injections of such as local anesthetic, steroids, or their combination; epidural injections, and radiofrequency ablations.
They analysed reviews of randomised trials and observational studies of these procedures.
Their recommendation, published in The BMJ, showed that there was no high-certainty evidence for any procedure or combination of procedures.
The low and moderate certainty evidence suggests "no meaningful relief for either axial pain (in a specific area of the spine) or radicular pain (radiating from the spine to the arms or legs) for spine injections compared with sham procedures", said the team, while strongly recommending against their use.
These procedures "are costly, a burden on patients, and carry a small risk of harm", they added, urging patients to avoid them.
