A widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment.
The study, the largest randomised trial evaluating the treatment, found that patients receiving a standard stenosis injection — which combines a steroid and a local anaesthetic — had no less pain and virtually no greater function after six weeks than patients injected with anaesthetic alone. The research, involving 400 patients at 16 sites, was published on Wednesday in The New England Journal of Medicine.
“Certainly there are more injections than actually should happen,” said Dr Gunnar Andersson, the chairman emeritus of orthopaedic surgery at Rush University Medical Center in Chicago, who was not involved in the research. “It’s sort of become the thing you do. You see this abnormality on the MRI and the patient complains, and immediately, you send the patient for an epidural injection.”
Some people can still benefit from injections, he said, but now physicians “will be more cautious” and patients should ask, “Should I really do this?’ “
Mostly, steroid injections are safe, carrying small risks of infection, headaches and sleeplessness. But in April, the Food and Drug Administration warned that they may, in rare cases, cause blindness, stroke, paralysis or death, noting that injections have not been FDA-approved for back pain and their effectiveness has “not been established”.
Often caused by wear and tear, spinal stenosis occurs when spaces within the spine narrow, putting pressure on nerves and causing pain or numbness in the back and the legs. More than a third of people over 60 have some narrowing, research suggests.
Steroid injections, which reduce inflammation, are often tried when physical therapy or anti-inflammatory medication fails, with the aim of avoiding expensive surgery.
The study provides evidence to tell some patients, “This probably isn’t going to work very well for you,” said Dr Ray Baker, a past president of the North American Spine Society and the International Spine Intervention Society, who was not involved in the study. And because some participants received two injections without greater benefit, “it strongly speaks against the practice of performing multiple injections.”
But the study also did not represent all types of stenosis, involving patients with central stenosis, not stenosis on one side, which Dr Andersson said was more localised, and