Hang On, You Might Not Need That Steroid Shot

Back pain relieved more with saline solution injections than with other methods

Steroids shot directly into a certain spot along the spine have been the most common treatment for pain in the lower back besides surgery. But these patients might not need the actual steroid to feel some relief.

A recent study found that placebo shots, or those that contain saline and no active ingredients, into the epidural space surrounding the spine lowered back pain about twice as much as having an actual steroid shot into the surrounding muscle.

According to the study's authors, the findings show that, for now, reducing the amount of steroids for patients might be advisable.

"Consider all your options to treat back pain. "

This study, led by Mark Bicket, MD, a physician resident at Johns Hopkins University School of Medicine, looked at the differences between epidural nonsteroidal injections and nonepidural injections into the muscle in treating back and neck pain. Epidural injections are targeted in the area that surrounds the spinal cord.

The researchers reviewed 43 studies that were published through October 2012. The included studies involved epidural injections of corticosteroids, non-epidural injections (such as injections directly into muscle tissue), other pain relieving medications and placebos, which are fake treatments with inactive ingredients.

Two reviewers independent from the current study noted the pain scores and outcomes from the 3,641 patients involved in the previous studies. Pain scores were gathered up to 12 weeks after treatment, which was considered short-term in the current study.

Epidural nonsteroid injections, including anesthetics and saline solution (the placebo), were more than twice as likely to lead to positive outcomes than non-epidural steroid injections into the muscle, the researchers found.

Nonsteroid solutions that are injected into the epidural space may provide pain relief in a number of ways similar to that provided by steroids, according to the researchers.

The researchers said that patients might be prone to the "placebo effect," in which patients think they're better although they are unaware that they were given an inactive medication.

“Just injecting liquid into the epidural space appears to work,” said Stephen Cohen, MD, co-author of the study and professor of anesthesiology and critical care medicine at Johns Hopkins, in a press release. “This shows us that most of the relief may not be from the steroid, which everyone worries about.”

The researchers noted, however, that the evidence for these findings was not very strong, as they only had a few, low-quality studies to compare the treatments patients received.

Furthermore, these three previous studies were not designed to look at the differences among nonsteroid treatment groups, nor between diluted steroid treatments and other treatments.

"Epidural injections have proven to be a very effective method of pain management. More research of long-term outcomes is needed," Satish Sharma, MD, a pain management physician at the Advanced Pain Management Center in Las Vegas, Nevada, told dailyRx News. 

This study, which was funded in part by the Centers for Rehabilitation Science Research under the Uniformed Services University of the Health Sciences in Maryland, was published in the October issue of the journal Anesthesiology.

No competing interests were declared.

Review Date: 
September 20, 2013