Commonly used injections offer little or no pain relief, says expert panel. Findings question whether it’s reasonable to continue to offer these procedures outside of clinical trials
Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief compared with sham injections, say a panel of international experts in The BMJ recently.
Their strong recommendations apply to procedures such as epidural steroid injections and nerve blocks for people living with chronic back pain (lasting at least 3 months) that is not associated with cancer, infection or inflammatory arthritis.
Their advice is based on the latest evidence and is part of The BMJ’s ‘Rapid Recommendations’ initiative – to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
Chronic back pain is the leading cause of disability worldwide. It is estimated to affect 1 in 5 adults aged 20-59, with higher rates likely among older adults. In 2016, low back and neck pain accounted for the highest healthcare spending in the US at $134.5 billion.
Procedures such as epidural steroid injections, nerve blocks and radiofrequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals reaching the brain, but current guidelines provide conflicting recommendations for their use.
So an international panel, made up of clinicians, people living with chronic spine pain, and research methodologists, carried out a detailed analysis of the latest evidence using the GRADE approach (a system used to assess the quality of evidence).
This evidence, based on reviews of randomised trials and observational studies, compared the benefits and harms of 13 common interventional procedures, or combinations of procedures, for chronic, non-cancer spine pain against sham procedures.
After careful consideration, the panel concluded that there was no high certainty evidence for any procedure or combination of procedures, and all low and moderate certainty evidence suggests no meaningful relief for either axial pain (in a specific area of the spine) or radicular pain (radiating from the spine to the arms or legs) for spine injections compared with sham procedures. As such, they strongly recommend against their us