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Steroid Shots for Low-Back Pain Offer No Long-Term Relief

Thursday, April 20, 2017

Many Americans suffer from chronic low back pain. And most try steroid injections to ease discomfort, however researchers now say this provides only short-term pain relief.

A study in France focused on 135 patients with back pain which was caused by inflammation between the discs and bones in the lower spine.

Researchers found a single steroid injection found to ease pain for one month. After the month, effectiveness waned. Little to no difference was seen one year after treatment between patients who did or didn’t receive the injection.

Lead researcher Dr. Christelle Nguyen said “Our results do not support the wide use of an injection of glucocorticoid in alleviating symptoms in the long term in this condition”.

Nguyen, an assistant professor of physical medicine and rehabilitation at Paris Descartes University, also said the findings are consistent with earlier studies.

Nguyen and her colleagues had hoped that by targeting local disc inflammation with an anti-inflammatory steroid would alleviate long-term pain.

To test their theory, researchers selected patients with chronic lower back pain and signs of disc inflammation on an MRI. Participants on average had suffered from back pain for six years. Half of the participants were assigned to a single steroid injection; the other half received no injection.

Patients had rated their pain severity before the injection, one, three, six and twelve months after the treatment.

One month post treatment, 55% of those who received the steroid injection experienced less low back pain, while 33% of those who weren’t treated experienced less pain.

Nguyen said “However, the groups did not differ for the assessed outcomes 12 months after the injection”.

So patients who did or did not receive a steroid injection ended up in similar circumstances, with the same incidence of disc inflammation, lower quality of life, more anxiety and depression and continued use of non-narcotic pain pills. Overall, most patients found the injection tolerable and would agree to have a second if necessary, Nguyen said. She added "We had no specific safety concerns and found no cases of infection, destruction or calcification of the disc 12 months after the injection”.

Dr. Byron Schneider, of Vanderbilt University School of Medicine in Nashville noted that the results don’t mean steroid injections should be avoided all together. Patients with sudden back pain, or acute pain, probably don’t need a steroid injection.

"But if they're not getting better after a month or two the way we would expect them to, at that point it would be reasonable to discuss the pluses and minuses of a steroid injection," said Schneider, co-author of an accompanying journal editorial.

"For chronic pain, physicians need to address the musculoskeletal reasons that cause the hurt, but also other reasons that patients may be experiencing pain," Schneider said.