International Experts Advise Against Spine Injections for Chronic Back Pain Relief

Recent findings from a panel of international experts have raised significant concerns regarding the use of spine injections for adults suffering from chronic back pain. According to a report published in The BMJ, these injections offer little to no more relief than placebo treatments.

The panel's recommendations specifically target procedures such as epidural steroid injections and nerve blocks, aimed at patients experiencing chronic back pain lasting for three months or more, excluding conditions linked to cancer, infections, or inflammatory arthritis. This guidance is a part of The BMJ's 'Rapid Recommendations' initiative, which aims to deliver trustworthy advice based on emerging evidence to assist healthcare professionals in making informed decisions.

Chronic back pain stands as the leading cause of disability globally, affecting approximately one in five adults between the ages of 20 and 59, with prevalence increasing among older populations. In 2016, healthcare costs associated with low back and neck pain in the United States reached a staggering $134.5 billion.

Despite the widespread use of interventional procedures such as epidural steroid injections and radiofrequency ablation--techniques designed to disrupt pain signals traveling to the brain--existing guidelines have shown conflicting recommendations concerning their effectiveness. In response, the expert panel, which included clinicians, individuals living with chronic spine pain, and research methodologists, conducted a comprehensive analysis utilizing the GRADE methodology, a system for evaluating the quality of evidence.

The panel's review encompassed a range of randomized trials and observational studies assessing 13 commonly employed interventional techniques for chronic spine pain, comparing their outcomes against sham procedures. The results were concerning; the experts found no strong evidence supporting the efficacy of any procedure or combination of treatments, with low and moderate certainty evidence indicating minimal to no relief from either localized or radiating pain associated with spine injections.

Consequently, the panel has issued a strong recommendation against the use of these injections, which encompass local anesthetic and steroid combinations, as well as radiofrequency ablation with or without additional anesthetic or steroid injections. The experts emphasized that these procedures not only carry financial burdens but also pose potential risks to patients, suggesting that most informed individuals would likely opt to avoid them.

The panel acknowledged the necessity for further research to potentially reshape future recommendations, especially for treatments currently characterized by low or very low levels of effectiveness. There is also a call for investigations into how these interventional procedures impact critical patient outcomes, including opioid consumption, employment reintegration, and sleep quality.

In a related editorial, a researcher from the University of Washington posed a critical question regarding the appropriateness of continuing to offer these procedures to patients with chronic back pain. The editorial emphasized the challenge of altering established medical practices, noting that as evidence increasingly contradicts the routine application of these injections, healthcare systems may become less inclined to finance them.

While this article may not be the final word on the topic, it contributes to the growing discourse that chronic pain management requires a fundamental reevaluation, advocating for a more balanced approach to reimbursements between procedural and non-procedural treatments for chronic pain.