August 2007

Injections not recommended for back pain

Chiropractors with patients considering epidural steroid injections to address their back pain should be aware of a new guideline developed by the American Academy of Neurology, which reveals that such injections play a limited role in providing short‑term pain relief for lower back pain that radiates down a leg, and do not provide long‑term pain relief.

According to the guideline, published in Neurology, the scientific journal of the American Academy of Neurology, epidural steroid injections may provide some short‑term pain relief between two and six weeks after injection, but the average amount of relief is small.

"While some pain relief is a positive result in and of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful," said researchers. Neither do epidural steroid injections help patients "buy time" to avoid surgery, or provide long‑term pain relief beyond three months, researchers found. In addition, the authors also found insufficient evidence to use epidural steroid injections to treat radicular cervical pain, or neck pain.

The use of epidural steroid injections to treat chronic back pain has increased during recent years. In 1999, Medicare claims for lumbar epidural steroid injections were $49.9 million, for 40.4 million covered individuals.