Steroid Shots May Not Help Back Pain
Exercise or surgery might be better options for narrowing of the spinal canal, researchers report
Andersson said that if there is an improvement after one injection, another can be tried. "But beyond the second injection, you shouldn't keep doing them," he said.
For the study, Friedly and colleagues randomly assigned 400 people with back and leg pain caused by spinal stenosis to injections of either a local anesthetic (lidocaine) alone or in combination with steroids.
The drugs were injected into the outermost space of the spinal canal.
Symptoms improved initially in both groups, the researchers found. Three weeks after the injections, those who received the steroid said they had slightly less leg pain and slightly better function.
At six weeks, however, there were no significant differences between the two groups in either pain or function, Friedly's team found.
Most people who got the steroid injection said they were satisfied with their treatment -- 67 percent said they were "very" or "somewhat" satisfied, compared with 54 percent of those given lidocaine alone. Those given the steroid also showed improvement in symptoms of depression, the researchers added.
Friedly thinks the increased satisfaction reported may be due to early benefit seen in the first three weeks. Steroids are also known to improve mood and reduce fatigue. These effects may have contributed to feelings of satisfaction.
People given steroids, however, had lower levels of the hormone cortisol, a steroid made by the body. That suggests the whole body was using the steroid from the injection. The side effects of steroids include reduced bone mineral density, increased risk of bone fractures and weakening of the immune system.
These findings mirror those of another study published last year in the journal Spine. In that report, researchers found that older adults who get steroid injections for degeneration in their lower spine may fare worse than people who skip the treatment.
The researchers found that people who got steroid injections did see some pain relief over four years. But they did not fare as well as folks who went with other conservative treatments or with surgery right away.
And if people who got steroids eventually opted for surgery, they did not improve as much as people who had surgery, but who hadn't had steroid shots.