Presumed Benefits of Corticosteroids for Lumbar Back Pain Were Not Proven

New research published in the July 3 issue of the New England Journal of Medicine suggests that epidural injections of a corticosteroid in combination with the local anesthetic lidocaine appear to be no better than injections of lidocaine alone in reducing pain and physical limitations in patients with spinal stenosis. Lumbar spinal stenosis is often caused by age-related changes in the spine, and it is estimated that over 2.2 million lumbar epidural injections are performed each year in the Medicare population.

The study, undertaken by researchers at the University of Washington, is the largest double-blind, randomized clinical trial to look at the purported effectiveness of this commonly administered treatment. Advocates of the treatment have hypothesized that the corticosteroids, also known as glucocorticoids, relieve pain by reducing swelling and inflammation around the compressed spinal nerves. But the research found no significant differences in either pain or function in the study population receiving the dual injections. Additionally, it is known that routine corticosteroid use can induce systemic effects including reduced bone mineral density, increased risk of bone fractures, and immunosuppression. A press release discussing the research may be read here.

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