Steroid Injections Didn't Offer Further Relief From Back Pain

Steroid treatment combined with local anesthetic did not improve spinal stenosis back pain when compared to anesthetic alone

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) As people age, many changes take place in their body. For some, one of those changes might be spinal stenosis, which can potentially lead to pain in the back and legs.

Spinal stenosis is the narrowing of open spaces in the spinal column. This narrowing can put pressure on the spinal cord and other nerves.

To deal with the pain caused by spinal stenosis, many people receive steroid shots. These shots carry the risk of infection, nerve damage and thinning of skin and tissue around the injection site, among other things.

And those risks may not be worth the benefit, according to a new study. The researchers found no difference in pain between patients who received the steroids and those who received a simple anesthetic.

"If you're receiving steroids for spinal stenosis, ask your doctor about the possible risks."

Janna Friedly, MD, assistant professor of rehabilitation medicine at the University of Washington in Seattle, was this study's lead author.

Dr. Friedly and colleagues set out to examine whether patients who received corticosteroid injections in combination with a local anesthetic had different pain levels and physical limitations than those who received only the anesthetic.

These two options are common treatments for spinal stenosis. In addition to back and leg pain, spinal stenosis can cause numbness, tingling or weakness in the legs.

For this study, Dr. Friedly and team randomly assigned 400 spinal stenosis patients to receive either a local anesthetic, in this case lidocaine, or a local anesthetic plus steroids.

Three and six weeks after the injections, study participants rated their pain on a 0-10 scale and their physical limitations on a 0-24 scale called the Roland-Morris Disability Questionairre.

The steroid group reported slightly less pain and physical limitation at the three-week mark compared to the anesthetic-only group.

But at the six-week mark, the researchers found no significant differences in the physical limitation or pain intensity scores between the groups.

Follow-up questions about satisfaction with treatment revealed that 67 percent of the patients who received steroids were “very” or “somewhat” satisfied, compared with 54 percent of those who received the anesthetic alone.

Dr. Friedly and colleagues chalked up the increased satisfaction to the minor early improvement in pain.

“Compared to injections with local anesthetic alone, injections with glucocorticoids provided these patients with minimal or no additional benefit,” Dr. Friedly said in a prepared statement.

"If patients are considering an epidural injection, they should talk to their doctor about a lidocaine-only injection, given that corticosteroids do pose risks and this study found that they provided no significant added benefit at six weeks," she said.

This study was published online July 3 in The New England Journal of Medicine.

The study was funded by a grant from the Agency for Healthcare Quality and Research.

Several authors disclosed holding stock or having consultancy positions with private companies.

Review Date: 
July 3, 2014
Last Updated:
July 5, 2014