Corticosteroid injections may not offer lasting benefit in low back pain

Corticosteroid injections offer only small, unsustained benefit for low back pain due to radiculopathy and spinal stenosis, a new study indicates.

Researchers performed a systematic review and meta-analysis of randomized trials that compared epidural corticosteroid injections with placebo injections or those that compared different injection techniques, corticosteroids, or doses in adults with radiculopathy and spinal stenosis. Studies published through May 2015 were included. Placebo interventions were defined as “epidural saline or local anesthetic injections without corticosteroid, a soft-tissue injection, or no injection.” The results of the review and meta-analysis were published online Aug. 25 by Annals of Internal Medicine.

Thirty trials evaluated corticosteroid injections for radiculopathy, and 8 evaluated corticosteroid injections for spinal stenosis. For radiculopathy, epidural corticosteroids improved pain, function, and surgery risk versus placebo in the short term, but the effects did not meet predefined minimum thresholds for clinically important differences, and no long-term benefits were noted. For spinal stenosis, no clear effects of corticosteroid injections were seen. The researchers found that serious harms of injections were rare but also noted that the reporting of harms was not optimal.

The current study included only trials published in English, and most had methodologic problems, among other limitations, the researchers noted. However, they concluded that epidural corticosteroid injections are linked to some immediate benefits in patients with radiculopathy but no long-term benefits and do not affect long-term surgery risk. Evidence on the effect of these injections for spinal stenosis is limited but also indicates no benefit, they said. The researchers called for additional research to clarify the benefits and harms of such injections for low back pain, including the possibility that they may work better “when given in the context of a more comprehensive pain management approach.”