FACET-JOINT STEROID INJECTIONS ARE INEFFECTIVE FOR LOW BACK PAIN

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FACET-JOINT STEROID INJECTIONS ARE INEFFECTIVE FOR LOW BACK PAIN.

Inflammation of the facet joints of the lumbar vertebrae is a cause of chronic low back pain. For that reason, steroid injection into the facet joints is commonly used as therapy, even though the only randomized trial of this treatment did not demonstrate any benefits.

In a new and better-designed study, a team from Quebec randomized 101 patients to receive methylprednisolone or placebo injections into the facet joints and carefully followed 95 of them for 6 months. Unlike in the earlier study, the researchers enrolled only patients who had reported immediate pain relief after injection of local anesthetic into the same joints.

After one month, when the most pronounced effects of steroid injection would be expected, 30 to 40 percent of patients reported marked symptomatic improvement, but there was no significant difference in improvement rates between the treatment groups. The same was essentially true 3 and 6 months after the injection.

This study indicates that steroid injection into the facet joints has little value in the treatment of chronic low back pain. An editorial notes the importance of assessing psychosocial factors that may amplify the pain, and cites nonsteroidal drugs, muscle relaxants, early ambulation, and exercise as useful treatments.

— ALK

Published in Journal Watch General Medicine October 11, 1991

Citation(s):

Deyo RA. Fads in the treatment of low back pain. N Engl J Med 1991 Oct 3 325 1039-1041.

Medline abstract (Free)

Carette S et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med 1991 Oct 3 325 1002-1007.