Take Home Messages:

Low back pain is common and often results in ongoing pain even after medical treatment. Treatment with corticosteroid injections into the site of pain has had mixed evidence so far.

Steroid injections may improve pain outcomes for up to one month after the onset of acute back pain if given early in the course of treatment. They may also reduce the need for more medical interventions and the use of pain relief medications in this time. It is hard to say from this study alone whether steroid injections are definitely better than placebo and a bigger study probably needs to be carried out to be sure.

Patients managed only with placebo were still experiencing significant pain one month after their first presentation, which shows how serious and disabling back pain can be. It also suggests that we need better treatment regimes so that patients can regain full function as early as possible.

Why the research matters:

Low back pain is common, especially in adults. Medical management of low back pain is difficult and many patients still have ongoing pain despite receiving treatment by a doctor. This means that we need better interventions to ensure that patients get relief from their symptoms sooner and more permanently.

It has been thought that corticosteroids may be an effective treatment for low back pain. However there has not been any strong evidence to support this theory. A study looking at using steroids early in patients with acute back pain could help improve treatment of these patients.

What the research involved:

To complete this study, 82 patients who presented to the emergency department with acute low back pain were selected and randomly allocated to two groups. One group received an injection of a steroid drug into their back, and the other group received an injection of placebo. Neither the patients nor the doctors knew who was receiving steroids and who was receiving placebo.

Both groups were followed up after one month and asked about ongoing pain. They were also asked about whether they had needed to use other pain medications, or whether they had needed to seek further medical attention for their back in this time. These outcomes were then analysed to find out whether the patients who received the steroid injection were better off than those in the placebo group.

Summary of research findings:

There was some evidence that receiving the steroid injection improved pain and reduced the need for ongoing pain medication. Unfortunately, the statistics were not conclusive. From this study alone it is not possible to clearly say that steroids have better treatment outcomes than no treatment.

The study does suggest the following outcomes regarding the use of steroids in back pain:

• Fewer patients who had received steroids needed follow up from a health professional in the month after leaving hospital.
• Pain was reported to have improved in more members of the steroid group than the placebo group.
• There were slightly more side effects reported in the group receiving steroids but not by a great deal.

Overall, more patients need to be included in a future study in order for the statistics on steroids to be clear.

The study also found that in the placebo group there were significant reports of ongoing pain one month after they had presented with their episode of acute pain. The study found that many of these patients could not yet return to their normal activities, even though they had received medical treatment for their back pain. This finding emphasises the importance of back pain and the impact it has on patients’ capacity to function.

Original research:

A randomized placebo-controlled trial of single-dose IM corticosteroid for radicular low back pain.

Friedman BW, Esses D, Solorzano C, Choi HK, Cole M, Davitt M, Bijur PE, Gallagher EJ.

Spine. 2008 Aug 15;33(18):E624-9.

Link to PubMed abstract