I have had chronic lower back pain for the last seven years that has not seen much relief. I’ve had physical therapy, I've been exercising, and three years ago had what I thought would bring an end to the pain -- steroid shots.
Under twilight sleep, they are done by a doctor to ease inflammation that causes such discomfort. I felt some temporary relief but the pain returned.
Interestingly, I just read a study that has shown these shots may be of no use at all for one spine condition called spinal stenosis. This is a condition where the spinal cord, especially the lower spine, is narrowed and causes pressure on the nerves of the spine.
You can read more about spinal stenosis here.
Researchers at the University of Washington in Seattle looked into the practice of steroid shots for those with spinal stenosis. They chose a random selection of 400 patients with spinal stenosis and gave them steroid shots in their lower spines.
Some patients received only an anesthetic injection in their lower spines, others received the anesthetic plus the steroid shots. Those with the additional shots felt relief in the weeks following, but the relief didn't last much longer.
One of the researchers was Dr. Janna Friedly, an assistant professor of rehabilitation medicine at the University of Washington in Seattle. Friedly said that after six weeks, there was no real difference in pain between either groups.
However, the injection of steroids had two interesting results.
One was that those who got the injections may have benefited from the known side effects of stress relief from steroids, as well as lessening tiredness. These may potentially be the real benefits that patients were feeling.
The other result was less heartening. These steroids can lower bone strength and the efficacy of the immune system.
Another concern that patients should consider is that those who went straight into surgery without the steroids actually fared better than those who tried steroids first. Doctors recommend that steroid use be carefully evaluated by the patient before going ahead with such a procedure.
It's also important to note that steroid shots may actually work for those with spine problems caused by inflammation. Since spinal stenosis is a structural problem of the spine, and is not an inflammation of the surrounding tissue, this may be the reason the steroid shots are not working.
Physical therapy can show great results for lower back pain and is used for the treatment of spinal stenosis. Non-steroidal medications can also be used to control pain. Physical therapy can be a great choice for those who do not want (or cannot have) injections or surgery.
Therapy can include:
- Hot or cold packs
- Stretching and strengthening exercises for back and abdominal muscles
- Education about how to deal with back problems
- Massage, especially if it is combined with education and exercise
- Ultrasound treatments or electrical stimulation
- Your doctor may recommend that you restrict activities for 3-6 weeks, then resume activities as soon as possible
Some short-term relief for non-spinal stenosis problems can be found in anti-inflammatories and massage. Other options include yoga, meditation and acupuncture.
EmpowHER has an excellent back pain center with lots of information about all kinds of lower back pain, causes, risks, treatment options and more. Click here for other articles and information.
MedlinePlus. HealthDay. “Steroid Shots May Not Help Back Pain”. Web. Retrieved July 13th, 2014.
EmpowHER.com. Bones and Joints. Lower Back Pain. Treatments. Web. Retrieved July 13th, 2014.
Friedly, Janna L. , M.D et al. A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis. N Engl J Med 2014; 371:11-21July 3, 2014DOI: 10.1056/NEJMoa1313265.
Reviewed July 22, 2014
by Michele Blacksberg RN
Edited by Jody Smith