Featured Research

from universities, journals, and other organizations

Need steroids? Maybe not for lower back pain

Date:
September 17, 2013
Source:
Johns Hopkins Medicine
Summary:
New research suggests that it may not be the steroids in spinal shots that provide relief from lower back pain, but the mere introduction of any of a number of fluids, such as anesthetics and saline, to the space around the spinal cord.

New research from Johns Hopkins suggests that it may not be the steroids in spinal shots that provide relief from lower back pain, but the mere introduction of any of a number of fluids, such as anesthetics and saline, to the space around the spinal cord.

Related Articles


For decades, epidural steroid injections have been the most common nonsurgical treatment for lower back pain even though extensive research shows mixed results. Placebo-controlled studies have found benefit only 60 percent of the time and it remains unclear whether the epidural steroids provide long-term pain control or reduce the need for surgery. Meanwhile, experts warn, steroids are a less-than-ideal treatment for some as they can raise blood sugar in diabetic back patients, slow wound healing in those who need surgery and accelerate bone disease in older women.

In a bid to lend some clarity, Johns Hopkins anesthesiologist Steven P. Cohen, M.D., and his colleagues reviewed dozens of published studies on the subject. As expected, they found that epidural steroid shots were more than twice as likely to bring relief as injections of steroids, saline or a local anesthetic like Lidocaine into muscle near the spinal canal. What was less expected, they report in the October issue of the journal Anesthesiology, was that epidural injections of any kind were also twice as good as intramuscular injections of steroids.

"Just injecting liquid into the epidural space appears to work," says Cohen, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "This shows us that most of the relief may not be from the steroid, which everyone worries about."

Cohen says concerns increased in 2012 when more than 740 people in 20 states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids made by a compounding pharmacy. Although better oversight might allay that concern, Cohen notes that patients can only get a limited number of steroid injections each year, even if their pain returns.

Cohen and Mark C. Bicket, M.D., an anesthesiology and critical care medicine chief resident at The Johns Hopkins Hospital, say it is too soon to recommend that patients stop receiving epidural steroids, but add that their analysis also suggests that smaller steroid doses can be just as beneficial. Larger studies are needed, they say, to determine whether steroid alternatives can be just as helpful for back pain patients.

"Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable," says Bicket, the study's first author.

Spinal pain is a leading cause of disability in the industrialized world, with lifetime prevalence for lower back pain ranging from 50 to 80 percent. Epidural steroid injections have been the standard treatment for debilitating back pain for over 50 years.

The Johns Hopkins review covered medical records of 3,641 patients from 43 studies conducted through October 2012. The studies compared epidural steroid injections to other sorts of epidural and intramuscular injections.

Cohen says his new analysis suggests that decades of mixed results of research on epidural steroid injections may have been due to the use of saline or anesthetic injections as the comparison "placebo" treatment. "It's likely that those studies were actually comparing two treatments, rather than placebo versus treatment," he says. "Researchers may be wasting millions of dollars and precious time on such studies."


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Mark C. Bicket, Anita Gupta, Charlie H. Brown, Steven P. Cohen. Epidural Injections for Spinal Pain. Anesthesiology, 2013; 119 (4): 907 DOI: 10.1097/ALN.0b013e31829c2ddd

Cite This Page:

Johns Hopkins Medicine. "Need steroids? Maybe not for lower back pain." ScienceDaily. ScienceDaily, 17 September 2013. <www.sciencedaily.com/releases/2013/09/130917181043.htm>.
Johns Hopkins Medicine. (2013, September 17). Need steroids? Maybe not for lower back pain. ScienceDaily. Retrieved December 17, 2014 from www.sciencedaily.com/releases/2013/09/130917181043.htm
Johns Hopkins Medicine. "Need steroids? Maybe not for lower back pain." ScienceDaily. www.sciencedaily.com/releases/2013/09/130917181043.htm (accessed December 17, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Wednesday, December 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Flu Outbreak Closing Schools in Ohio

Flu Outbreak Closing Schools in Ohio

AP (Dec. 17, 2014) A wave of flu illnesses has forced some Ohio schools to shut down over the past week. State officials confirmed one pediatric flu-related death, a 15-year-old girl in southern Ohio. (Dec. 17) Video provided by AP
Powered by NewsLook.com
Yoga Could Be As Beneficial For The Heart As Walking, Biking

Yoga Could Be As Beneficial For The Heart As Walking, Biking

Newsy (Dec. 17, 2014) Yoga can help your weight, blood pressure, cholesterol and heart just as much as biking and walking does, a new study suggests. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins