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This common back-pain treatment is of little help

One question you need to ask: ‘Should I really do this?’

A widely used method of treating a common cause of back and leg pain – steroid injections for spinal stenosis – may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment.

Hundreds of thousands of injections are given for stenosis each year in the United States, experts say, costing hundreds of millions of dollars.

But the study, the largest randomized trial evaluating the treatment, found that patients receiving a standard stenosis injection – which combine a steroid and local anesthetic – had no less pain and virtually no greater function after six weeks than patients injected with anesthetic alone. The research, involving 400 patients at 16 medical centers, was published in The New England Journal of Medicine.

“Certainly, there are more injections than actually should happen,” said Dr. Gunnar Andersson, chairman emeritus of orthopedic surgery at Rush University Medical Center in Chicago, who was not involved in the research. “It’s sort of become the thing you do. You see this abnormality on the MRI and the patient complains, and immediately you send the patient for an epidural injection.”

Some people can still benefit from injections, he said, but now physicians “will be more cautious,” and patients should ask, “Should I really do this?”

Often caused by wear and tear, spinal stenosis occurs when spaces within the spine narrow, putting pressure on nerves and causing pain or numbness in the back and legs. More than a third of people older than 60 have some narrowing of the spinal canal, research suggests.

Steroid injections, which reduce inflammation, are often tried when therapy or anti-inflammatory medication fails, with the aim of avoiding expensive surgery, which itself is inappropriate for some patients.

The new study provides evidence to tell some patients, “This probably isn’t going to work very well for you,” said Dr. Ray Baker, past president of the North American Spine Society and the International Spine Intervention Society, who was not involved in the study. And because some participants received two injections without greater benefit, he added, “it strongly speaks against the practice of performing multiple injections.”

But the research also leaves the options for some patients unclear.

“We don’t have a lot of good things in our toolbox for spinal stenosis,” he added. “We’re really stuck with a problem, especially with an aging population.”



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