Steroid Injections

Epidural steroid injections commonly used to treat low back pain may be of no benefit, a US study suggests.

Patients who received steroid injections did experience modest pain relief, but the improvement was short lived and not statistically greater than with placebo.

The results come from a three-arm randomised trial in 84 adult patients with lumbosacral radiculopathy. The patients received two epidural injections, separated by 2 weeks, of methylprednisolone acetate, the cytokine inhibitor etanercept, or saline placebo.

A month later, the greatest reduction in the primary outcome of leg pain, as well as in back pain, was seen among patients who had received the steroid injections.

However, the pain reductions relative to those achieved among patients who received etanercept or saline were modest, and did not reach statistical significance.

In terms of functional capacity, both the steroid and saline groups achieved significantly greater improvements than the etanercept group, in which very little change was seen due largely to worsening in the aspects of sleep and sex life.

Although a greater proportion of patients treated with epidural steroids reported 50% or greater leg pain relief and a positive global perceived effect at 1 month, the benefit relative to the other groups was lost by 3 months.

Reporting their findings in the Annals of Internal Medicine, Dr Steven Cohen (John Hopkins School of Medicine, Baltimore, Maryland) call for larger studies with longer follow-up to test the benefits of steroid injections further.