For more than five decades, non-surgical scenarios for severe back pain have as a rule featured epidural steroid injections. But it appears that relief can also be provided by injecting other liquids into the spinal area, for example anesthetics or saline, according to a study whose results have been published in the current issue of Anesthesiology.
The study was led by Steven P. Cohen, anesthesiology professor at the Johns Hopkins University School of Medicine. With the help of colleagues, he carried out a review of 43 studies conducted before October 2012, examining the records of 3,641 patients. The team compared the effect of epidural steroid shots to that of other epidural shots and intramuscular injections.
It came as no surprise to the researchers to find that epidural steroid injections were more than twice as likely to provide relief as intramuscular injections of steroids, saline or a local anesthetic. However, they also found that any kind of epidural shots had an equally high chance of success compared to intramuscular steroid injections.
As Cohen noted, it seems that simply injecting a liquid into the designated spinal area produces the desired effect. The conclusion is that steroids may not provide most of the relief and this is welcome news, given the concerns associated with these compounds.
Cohen and his colleagues are not yet ready to recommend the elimination of epidural steroids from the treatment options for patients with severe low back pain. But they do note that smaller steroid doses appear to produce the same benefits. It will take further studies, and ones on a larger scale, to establish whether patients can benefit to the same extent from steroid alternatives.