Navigation Links
Steroid Shots Disappoint in Back Pain Study
Date:3/7/2013

By Amy Norton
HealthDay Reporter

THURSDAY, March 7 (HealthDay News) -- Older adults who get steroid injections for degeneration in their lower spine may fare worse than people who skip the treatment, a small study suggests.

The research, published recently in the journal Spine, followed 276 older adults with spinal stenosis in the lower back. In spinal stenosis, the open spaces in the spinal column gradually narrow, which can put pressure on nerves. The main symptoms are pain or cramping in the legs or buttocks, especially when you walk or stand for a long period.

The treatments range from "conservative" options like anti-inflammatory painkillers and physical therapy to surgery. People often try steroid injections before resorting to surgery. Steroids calm inflammation, and injecting them into the space around constricted nerves may ease pain -- at least temporarily.

In the new study, researchers found that patients who got steroid injections did see some pain relief over four years. But they did not fare as well as patients who went with other conservative treatments or with surgery right away.

And if steroid patients eventually opted for surgery, they did not improve as much as surgery patients who'd skipped the steroids.

It's not clear why, said lead researcher Dr. Kris Radcliff, a spine surgeon with the Rothman Institute at Thomas Jefferson University, in Philadelphia.

"I think we need to look at the results with some caution," he said. Some of the study patients were randomly assigned to get steroid injections, but others were not -- they opted for the treatment. So it's possible that there's something else about those patients that explains their worse outcomes, Radcliff said.

On the other hand, he said, steroid injections themselves might hamper healing in the long run. One possibility is that injecting the materials into an already cramped space in the spine might make the situation worse, once the initial pain-relieving effects of the steroids wear off, Radcliff explained.

"But that's just our speculation," he said.

A pain management specialist not involved in the work said it's impossible to pin the blame on epidural steroids based on this study. For one, it wasn't a randomized clinical trial, where all patients were assigned to have steroid injections or not have them, said Dr. Steven Cohen, a professor at Johns Hopkins School of Medicine, in Baltimore.

The patients who opted for epidural steroids "may have had more difficult-to-treat pain, or a worse pathology," Cohen said.

He also noted that there is evidence from other research that epidural steroids can help some patients delay spine surgery.

"Epidural steroids won't work for everyone, but they're going to work for some people," said Cohen, adding that he would "absolutely" suggest patients give them a shot if they want to put off surgery.

Epidural steroids should be seen as a "tool in the toolbox," said Dr. Eric Mayer, of the Center for Spine Health at the Cleveland Clinic, in Ohio.

If the goal is to get some symptom relief and possibly delay surgery, then patients may want to try the injections, according to Mayer.

"This study is interesting," he said. "But it really does nothing to inform medical practice."

Epidural steroids have been the subject of some press recently. U.S. officials are currently investigating a deadly outbreak of fungal meningitis linked to epidural steroids produced by one Massachusetts pharmacy.

The patients in the current study came from 13 spine treatment centers in 11 U.S. states. Radcliff said there was no evidence of infections or other serious side effects from the treatment. "So, it did appear to be safe," he said.

Radcliff said he wouldn't discourage the use of steroid injections for patients who want to try them. "It's still reasonable to offer this as an option," he said. "These patients did improve; they just didn't improve as much as the others."

He also pointed out that spinal stenosis is just one cause of low back and leg pain. Other conditions can pinch a nerve and cause similar symptoms, such as a herniated disc.

Cohen said that in general, patients with a herniated disc respond better to steroid injections than those with spinal stenosis -- though people with a herniated disc also have a good shot at getting better with no treatment.

Unlike a herniated disc, spinal stenosis is a progressive condition, and it won't be "cured" with any treatment. Even after surgery, Cohen said, your symptoms may well come back at some point.

With epidural steroid injections, there's no consensus on how long you can keep getting them.

But the general guideline is to have no more than three to six injections in a year, Cohen said -- though that's based on expert opinion rather than hard evidence. And just one injection at a time seems to be enough, Cohen noted. Some doctors are in the habit of doing three in one go, but there's no evidence that it benefits patients.

If you do go for epidural steroid injections, it would be wise to make sure your insurance covers it: in the United States, one injection can cost a few hundred dollars.

The study was funded by the U.S. National Institutes of Health and the U.S. Centers for Disease Control and Prevention.

More information

Learn more about low back pain from the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Kris Radcliff, M.D., Rothman Institute, Thomas Jefferson University, Philadelphia; Steven P. Cohen, M.D., professor, Johns Hopkins School of Medicine, Baltimore; Eric Mayer, M.D., director, outcomes, Cleveland Clinic Center for Spine Health, Ohio; Feb. 15, 2013, Spine


'/>"/>
Copyright©2012 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Gatekeeper of brain steroid signals boosts emotional resilience to stress
2. Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study
3. Steroid Nasal Sprays Show Small Benefit for Sinusitis: Study
4. Identifying asthma patients who tolerate lower doses of steroids remains problematic
5. Trivedi Beef, LLC Announces Breakthrough Beef Industry Data without the use of Antibiotic Drugs, Hormones or Steroids
6. Low steroid levels linked to increased risk of cardiovascular disease
7. Vitamin D deficiency and poorer lung function in asthmatic children treated with steroids
8. The scientific side of steroid use and abuse
9. Steroids Wont Ease Most Sinusitis Attacks, Study Finds
10. Children taking steroids for asthma are slightly shorter than peers
11. For Mild Asthma, Daily Steroids May Not Be Needed, Study Says
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Steroid Shots Disappoint in Back Pain Study
(Date:2/5/2016)... ... February 05, 2016 , ... Looking for a last-minute Valentine’s ... the tips of your toes. Foot massage, whether administered by a professional masseuse or ... relaxation. The American Board of Multiple Specialties in Podiatry (ABMSP) has taken ...
(Date:2/5/2016)... Rafael, CA (PRWEB) , ... February 05, 2016 , ... ... with ChildLight Yoga Studio in Dover, NH to direct high-performance kids yoga training. ChildLight ... New Hampshire’s seacoast, just one hour from Boston. , ChildLight Yoga Studio founder Lisa ...
(Date:2/5/2016)... ... 05, 2016 , ... Give To Cure today announced that it ... to Give To Cure’s campaign that is crowdfunding clinical trials to help find cures ... payments through a smart device. In 2015 alone, Venmo processed $7.5 billion in transactions ...
(Date:2/5/2016)... (PRWEB) , ... February 05, 2016 , ... Dr. Justin ... announce their 2nd Annual No Cost Dental Day to individuals in need. The event ... purpose of this No Cost Dental Day is to provide dental care to community ...
(Date:2/5/2016)... (PRWEB) , ... February 05, 2016 , ... In sleep, ... form as a dream. A hallmark feature of patients with eating disorders is significant ... The eating disorder behaviors and obsessions are regarded as maladaptive means for coping with ...
Breaking Medicine News(10 mins):
(Date:2/4/2016)... , Feb. 4, 2016   Bernstein Liebhard LLP ... filed in the United States District Court for the District ... class (the "Class") consisting of all persons or entities who ... "Company") (NASDAQ: INSY ) from March 3, 2015 through ... and certain of its officers with violations of the Securities ...
(Date:2/4/2016)... 4, 2016  Montoya Love is recognized by Continental ... of Pharmaceuticals. Montoya is the Regulatory Systems Operations Manager ... Manufacturing and selling a broad ... provides healthcare institutions, clinical laboratories and life science ... across the globe. ...
(Date:2/4/2016)... 2016 Frontier Pharma: Chronic Obstructive Pulmonary ... Chronic Obstructive Pulmonary Disease (COPD) ... of the airways and lungs. Persistent breathing difficulties ... disease one of the leading causes of morbidity ... world. COPD is linked to cumulative exposure to ...
Breaking Medicine Technology: