Chronic back pain and injections

http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

National Institute of Neurological Disorders and Strokes

Low Back Pain Fact Sheet

Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.

Epidural steroid injections are a commonly used short-term option for treating low back pain and sciatica associated with inflammation. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.

Click to access lbpinject-topicref.pdf

Pain Management Injection Therapies for Low back Pain (9/19/2014)

Between 1994 and 2001, use of epidural injections increased by 271 percent and facet joint
injections by 231 percent among Medicare beneficiaries.19 Total inflation-adjusted reimbursed
costs (based on professional fees only) increased from $24 million to over $175 million over this
time period. More recent data indicate continued rapid growth in use of spinal injection therapies among Medicare beneficiaries, with an increase of 187 percent in use between 2000 and 2008…

Given the continued growth in use of injection therapies for low back pain and continued
uncertainty regarding their role and optimal use, a systematic review to summarize the current
state of evidence, identify and evaluate inconsistencies in the evidence, and identify important
research gaps is warranted to help inform clinical practice and policy…

Despite these dramatic increases, use of injection therapies for low back pain remains
controversial. Systematic reviews of injection therapies have come to conflicting conclusions
regarding the benefits of injection therapies and clinical practice guidelines provide
discordant recommendations regarding their use…

http://www.bmj.com/content/350/bmj.h1748

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study (April 16, 2015)

Conclusions:  Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.

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