A meta-review of nearly forty studies found that epidural steroid injections were no better than placebos in reducing pain after an initial 6-week period, nor did they reduce the need for future surgery.
Bad news for back pain sufferers: evidence is mounting that epidural steroid shots may give short-term relief, but in the long run, they are no better than placebos.
In a review published on Monday in Annals of Internal Medicine, researchers analyzed data from nearly forty separate placebo-controlled studies of epidural steroid injections. Thirty studies focused on treatment for radioculopathy, or back pain that radiates down the legs; eight studies focused on spinal stenosis, which is back or neck pain caused by the narrowing of the spinal canal. (The authors of the review noted that most of these trials had methodological shortcomings, and some were based on small sample sizes.)
According to the review, injections given to treat radioculopathy provided some short-term pain relief. However, in the long run, the injections were not superior to placebos in terms of providing pain relief, nor did they reduce the need for surgery in the future.
Similarly, injections given to treat spinal stenosis were shown to be helpful in reducing pain during the first six weeks following the shot. However, after that initial period, the steroid shots provided no significant advantage over placebos in terms of controlling pain intensity or increasing a patient’s ability to function.
These findings beg the question, why do doctors continue prescribing these shots, which are not without their own negative side effects?
Dr. Roger Chou, lead author of the review, gave his view on the continued use of epidural steroid injections: “One of the reason that people advocating for this [treatment] are doing it is because they see people in horrible pain and are able to see that they do have some relieve afterward. There is a placebo effect, so there’s a contrast there with what [health care providers] see anecdotally and what’s in the study.”