Monday, September 7, 2015

Steriod Injections Probably Won’t Help Your Low Back Pain

Steroid injections for low back pain may provide some relief for certain patients, but any benefits are temporary, a new study finds.

Low back pain related to herniated disk and, to a lesser degree, spinal stenosis (narrowing of the spinal canal), is often treated with epidural steroid injections, the researchers said. But after reviewing 38 previously published studies, the researchers found no strong evidence to support their use for these conditions.

“These injections may not be as effective as perceived, and decisions should be based on an informed discussion of risks, benefits, and potential options, including surgery, medications and non pharmacological options like exercise therapy,” said lead researcher Dr. Roger Chou, a professor of medicine at the Oregon Health & Science University.

Chou said lower back pain usually improves over time without treatment, but some patients may want relief sooner.

“Patients may have a perception that these injections reduce the need for surgery or result in long-term benefits,” Chou said. “It’s important for them to understand that benefits appear to he short-lived and to weigh these short-term benefits against potential complications of the injections, such as infection and nerve injury.”

The report was published August 24 in the Annals of Internal Medicine.

My Take:
This study parallels my clinical experience. I have a new patient who is considering steroid injections as I write this blog. He mistakenly sees this option as a quick fix that will avoid surgery.

Epidural steroid injection may provide temporary relief than can lead to recovery when combined with conservative chiropractic care. Unfortunately, patients (and physicians) often see it as a stand alone therapy.

In my opinion, injecting steroids into the spine has no place in the treatment of low back pain. It is an option to try to delay surgery when treating neuropathy associated with radicular leg numbness, tingling, weakness, loss of deep tendon reflexes, and muscle atrophy. In such cases, nerve function must be restored before the nerve damage becomes permanent. Typically, the window of opportunity is no more than six weeks before surgical intervention is mandated.

Fortunately, a vast majority of low back pain is not complicated by neuropathy. It responses rapidly to natural methods of reducing inflammation (like fish oil, turmeric, ginger, or boswellia), chiropractic manipulation, and restoration of neurological reflex pathways.

The Bottom Line:
Unless you have demonstrable neuropathy - loss of deep tendon reflexes, vibrational sense, or muscle atrophy, avoid epidural steroid injections for low back pain. Seek alternative care with a chiropractic physician.

Source: August 24, 2015 National Institutes of Health

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