Epidural Injections May Do More Harm Than GoodMay 25, 2018
Epidural injections may do more harm than good
A patient will often ask us about the differences between Prolotherapy, Platelet Rich Plasma Therapy, Stem Cell Therapy, and Epidural steroid injection. Research suggests that the differences is in the patient outcome.
In a study in the International journal of technology assessment in health care, investigators wrote: “Epidural steroid injection did not significantly decrease the number of patients who underwent subsequent surgery compared with a placebo or other treatments.” 1
Further, as reported in the journal Anaesthesiology intensive therapy, the side-effects of a treatment that is not showing the desired results long-term: “Epidural steroid injection while one of the most widely used techniques to treat radicular pain, must be administered cautiously, with careful monitoring for systemic side effects.”2
Further, doctor’s looking at Worker’s Compensation cases found that epidural lumbar injections after the first lumbar surgery were associated with longer claim duration.3 Epidurals did not get people back to work faster.
Researchers in the United Kingdom studying determining factors in treating mild, moderate, and severe chronic low back pain noted that “despite greater use of medications at greater chronic low back pain severity, current options remain less than optimal in providing analgesic efficacy.” 4
Worse, recent studies suggest that epidural injections of steroids for back problems may do more harm than good. In one study doctors found epidural steroid injections were associated with longer duration of surgery for those patients who went unto spinal surgery and longer hospital stay. 5
Research suggests that postmenopausal women are at risk for bone mineral density loss when being treated with epidural steroid injection for chronic pain. Researchers writing in the medical journal Spine noted that epidural steroid injection (ESI) are used to treat the pain associated with radiculopathy (as in pain radiating along the sciatic nerve running down one or both legs from the lower back.) but its effect on bone mineral had not been examined at length,
Twenty eight postmenopausal women suffering from radiculopathy
They looked at Twenty eight postmenopausal women suffering from radiculopathy who elected L4-L5 ESI treatment. They noted significant decline in the hip BMD at 6 months compared to baseline. Here is what they concluded:
“…Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in BMD, while slight, suggests that ESIs should be used with caution in those at a risk for fracture.”6
Back pain sufferers need treatment, but what type?
A recent study published in the Journal of the Canadian Medical Association noted what may be obvious to some: The sooner you treat back pain, the better the chance to alleviate pain and prevent later disability. Here is what they said: “Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain.”7
This study did not gauge the types of treatment per se, but just that some type of treatment was preferable.
Unfortunately for many, the first line of treatment for low back pain is some type of medication. Obviously, medications can only mask the pain and not heal it. This often leads patients and doctors to be at odds over the effectiveness of their pain management.
In the medical journal Pain Practice, researchers noted that in their study of over 100,000 patients with chronic low back pain or osteoarthritis – “Opioids were the most frequently prescribed medication (more than 70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs more than 50%). Over 30% received antidepressants, more than 20% received benzodiazepines, and 15% in each group received sedative-hypnotics.
When In Doubt, Contact Us
Contact us at the Magaziner Center For Wellness, we can give you and thorough assessment and suggest the best course of treatments, based on your condition.
We do our best to bring you updated news on treatments, but in-person we can discuss any ailments and treatments and give you the best information based on research.
1. Choi HJ, Hahn S, Kim CH, Jang BH, Park S, Lee SM, Park JY, Chung CK, Park BJ. Epidural steroid injection therapy for low back pain: a meta-analysis. Int J Technol Assess Health Care. 2013 Jul;29(3):244-53. doi: 10.1017/S0266462313000342. Epub 2013 Jun 17.
2. Bellini M, Barbieri M. Systemic effects of epidural steroid injections. Anaesthesiol Intensive Ther. 2013 Apr-Jun;45(2):93-8. doi: 10.5603/AIT.2013.0021.
3. Tao XG, Lavin RA, Yuspeh L, Bernacki EJ. Implications of Lumbar Epidural Steroid Injections After Lumbar Surgery. J Occup Environ Med. 2014 Jan 21. [Epub ahead of print]
4. Taylor-Stokes G, Lobosco S, Pike J, Sadosky AB, Ross E. Relationship between patient-reported chronic low back pain severity and medication resources.Clin Ther. 2011 Nov;33(11):1739-48. Epub 2011 Oct 15.
5. Radcliff K, et al. Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis: A Subgroup Analysis of the Spine Patient Outcomes Research Trial Spine. 15 February 2013 – Volume 38 – Issue 4 – p 279–29
6. Al-Shoha A, et al. Effect of Epidural Steroid Injection on Bone Mineral Density and Markers of Bone Turnover in Postmenopausal Women. Spine doi: 10.1097/BRS.0b013e318270280e
7. Ghodraty MR, Nikzad-Jamnani AR, Nader ND. Adjuvant hyaluronidase to epidural steroid improves the quality of analgesia in failed back surgery syndrome: a prospective randomized clinical trial. Jan-Feb;17(1):E75-82.