Sticking It to Injection Therapy ResearchChronic low back pain takes its toll on society, both in human suffering and cost of treatment. There are many remedies available, but only a few have proved effective so far. Injections with anesthetics, steroids, or both are one way to treat patients with chronic low back pain, but do they work?
This article reviews 21 studies of injection therapy between 1966 and 1998. The authors reported on the results of three types of injection therapy. They also examined the methods each study used to get these results, to see whether the results could be trusted.
Each of the studies involved patients who had low back pain for more than one month. The patients had one of three types of injections. The first type, facet-joint injections, were injected into the small joints that link along the back of the spinal column. Epidural injections were given into the membrane around the spinal cord. Finally, local injections were applied to trigger points in the muscles of the back, ligaments, or other tissues around the spine.
The best way to determine if injection therapy works is to compare it to placebo--or "empty"--injections. Only 11 of the studies did this. Based on these studies, none of the injection therapies worked miracles for low back pain. Patients who had injection therapy tended to have more pain relief than patients who received placebos, but this tendency was slight.
The methods used in the studies were generally poor. On a scale of one to 100, only eight of the studies reviewed received scores of 50 or more. Clearly, better research on injection therapy is needed.
There is no strong evidence that injection therapy works. However, it seems to have some good short-term results with few side effects, so it shouldn't be abandoned completely. The authors emphasize the need for more studies that compare injection therapy with placebos for long-term pain relief.
P. J. Nelemans, MD, PhD, et al. Injection Therapy for Subacute and Chronic Benign Low Back Pain. In Spine. March 1, 2001. Vol. 26. No. 5. Pp. 501-515.
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