It’s estimated more than 2 million Americans get powerful steroid injections for chronic back pain every year. For sometime doctors have been wondering if the shots really work
Now a major new study published in the New England Journal of Medicine questions their value for a common condition called spinal stenosis—a narrowing of the space that houses the spine resulting in painful compression of the nerves.
According to lead researcher Dr. Janna Friedly from the University of Washington in Seattle, “There is no added benefit to the steroid itself.” Her advice to patients: “I would recommend they consider an alternative.”
However, like all such studies, the research leaves some questions unanswered.
In particular, why do steroids help many but not all patients?
Spinal stenosis is more common in people age 60 and older. The injections, according to a government study, cost $637 including $132 for professional services. Since Medicare covers the procedure, it’s reasonable to ask, are they value added?
Doctor Friedly is a physician specializing in rehabilitation medicine, but there are legitimate differences among researchers and clinicians about the best ways to treat spinal stenosis. Given that an estimated 80 percent of Americans suffer from chronic back pain, shouldn’t we consider every reasonable alternative?
Fair to say this approach is not for everyone. There are many less invasive ways to get relief including acupuncture, physical therapy, and lifestyle changes as well as non-prescription and prescription pain relievers. Many patients are helped by natural treatments that reduce inflammation without the potential for side effects, including addiction.
Because pain is such a subjective experience, managing spinal stenosis is a challenge that isn’t easily resolved just by looking at the numbers even if they appear convincing.
While the effectiveness of repeated injections may be questionable, as the article suggests, there is a lot of clinical evidence that for the right patient, the shot is the right choice: Those with chronic leg rather than back pain tend to do well, as do those who are otherwise healthy. Of course, it always helps to get diagnosed early with rapid follow-up.
The treatment aims to limit chronic pain and inflammation when the spinal nerve is squeezed, and there is agreement that steroid injections are an effective way to treat nerve pain from bulging discs.
While every drug has side effects, the amount of steroids used in a spinal stenosis procedure is small as is the commensurate risk. It’s important to put the downside in context since many patients are pain free after the injection.
No question the spinal stenosis study is worthy of media and medical attention. However, it’s only one view of a complicated issue that may appear very different if you’re the person in pain.