Spinal Injections Only Marginally Effective

The Annals of Internal Medicine released a report on the effectiveness of steroid spinal injections.  The report showed “benefits were small and not sustained, and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis” (AIM, 2015).

Always consider risk-reward-cost when thinking about spine treatments.

Always consider risk-reward-cost when thinking about spine treatments. Featured image courtesy of FreeDigitalPhotos.net and Stuart Miles

Whenever a patient must undergo a procedure, one must always weigh the risk vs benefit and factor in the cost of the procedure.  In a perfect world, risk would be low, cost would be low and benefit would be high.  The reality of spinal treatments is that they are very expensive, generally safe, and only minimally effective.  That is a poor combination.

This new study showed that the steroid injections showed no benefit for stenosis, which is a narrowing of the canal in which the nerves reside.

The public is lead to believe that these injections are effective for pain, which is a fallacy.  They are not effective.   If the injections were free and carried no risk, then it might be a better deal for patients.

Steroids used in the injections are generally safe but they do pose some rare risks, including:

  • elevated blood sugar
  • hypertension
  • osteoporosis
  • menstrual irregularity
  • suppression of the body’s stress system
  • Cushing’s syndrome

The injection itself has some risk of complication:

  • meningitis
  • inflammation of the lining of the spinal cord
  • damage to the spinal cord
  • nerve injury
  • paralysis
  • epidural abscess, which can cause incontinence, urinary retention, fever, and back pain
  • headaches
  • dizziness
  • facial flushing
  • increased back or leg pain
  • nausea
  • vomiting
  • pain at the injection site

How must does it cost?  According to Pain Physician, a trustworthy peer-reviewed research journal, “This cost utility analysis of caudal epidural injections in the treatment of disc herniation, axial or discogenic low back pain, central spinal stenosis, and post surgery syndrome in the lumbar spine shows the clinical effectiveness and cost utility of these injections at less than $2,200 per one year of QALY.” (Pain Physician. 2013 May-Jun;16(3):E129-43.)

So what else can be done?  See the chiropractor.  We are safe and effective.  There are lots of studies that show that chiropractic care is beneficial for back pain.  You can scan our website for research articles showing the safety and efficacy of chiropractic care.

Dr. Andrew White | St George Chiropractor

References:

Pain Physician. 2013 May-Jun;16(3):E129-43.

Ann Intern Med. Published online 25 August 2015 doi:10.7326/M15-0934

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