Epidural Steroid Injections

Epidural steroid injections are commonly offered to people suffering with lower back pain. These are back pain injections, which are put into the space between the vertebra and the spinal cord.

The problem is that we don't really know whether they work or not as this recent Cochrane study on back pain injections shows.

However, it could be assumed that having an epidural injection is probably better than having surgery, so if it reduces the need for surgery perhaps it’s a good thing. This year a new study took a look at  that question.

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The authors looked at the numbers of people getting epidural steroid injections for lower back pain in 2001 across the USA and compared different areas to see if the numbers were similar.

They then looked to see if the people who had the injections were less likely to have surgery later on.

There are big differences depending on where you live

The results make fascinating reading. The most extraordinary thing is how much the rates of injections varied across the USA. There were huge regional variations. For example:

  • there was a 7.7-fold difference between the state with the lowest rate Hawaii at 5.2 per 1000
  • and the state with the highest rate Alabama at 39.9 per 1000.

This became even more marked when they looked at smaller regions:

  • There was an 18.4-fold difference from 5.6 per 1000 having injections in Honolulu, Hawaii
  • to 103.6 per 1000 in Palm Springs, California! 

So… is Palm Springs the back pain capital of the USA?

Does this mean that people who live in Palm Springs have worse back pain? Somehow I doubt it!

I think it tells us that the decision to inject is based on many different things. It is not simply based on the back problem but probably includes:

  • your expectations – what you want and what you think will work
  • the doctors preferences – what they think will work
  • habits and training – doctors talk to each other and share ideas about treatment
  • the availability of the treatment - if it is commonplace or rare
  • other influencing  things.

Do steroid injections stop people having surgery?

No, the opposite actually. The paper found that the people that had an epidural steroid injection were significantly more likely to go on and have surgery.

So epidural injections do not appear to be substituting for or reducing rates of lumbar surgery.

Is it worth having an injection?

Sometimes these injections can be incredibly helpful, but I also think it's wrong to assume that epidural steroid injections will automatically help everyone.

 
Having a good, open discussion with your doctor is the key to making a decision.

 

References

1. Friedly, J., Chan, L. & Deyo, R. Geographic variation in epidural steroid injection use in medicare patients. J Bone Joint Surg Am 90, 1730-7(2008).

 

25-Jan-2013

 

 

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