Epidural steroid injections
ChaNaWiT/Shutterstock Modern medicine isn’t perfect, and sometimes doctors prescribe medical interventions out of habit even though new evidence shows they’re not effective, too dangerous, or don’t always work. One of these is epidural steroid injections for back pain. Although these shots may work short-term, they have risky potential complications like neurological problems or paralysis. “Generally, epidural steroid injection isn’t very useful for treatment of chronic back or neck pain,” says Steven Severyn, MD, an anesthesiologist at the Ohio State University Wexner Medical Center. In addition, research has shown the injections haven’t reduced the number of back surgeries. If the pain is caused by nerve issues (sciatica) instead of arthritis, “it will often relieve nerve inflammation causing the limb pain and allow time for naturally occurring improvement to take place,” Dr. Severyn says. However, the injections’ usefulness is still only short-term. Other treatments for back pain, such as physical therapy, can be a better plan for long-term improvement. Don’t miss these medical procedures and treatments you can do at home.
wavebreakmedia/Shutterstock Unfortunately, surgery for back pain isn’t always a good option either. For some conditions, says Dr. Severyn, it can be helpful: spinal instability; loss of limb, bowel, or bladder motor functions; spinal infection; and other severe issues. But, back surgery shouldn’t be an option for chronic lower back pain, he says. And even when surgery is indicated, surgeons are using unnecessarily complicated procedures, suggests a study from Sweden. In the random trial, patients with spinal stenosis got either a simple procedure called decompression which relieved pressure on the nerves, or they underwent decompression with spinal fusion, in which adjacent vertebrae are screwed together to give the spine more stability. The study found that the outcomes in both patients were the same, but the spinal fusion patients had a greater risk of bleeding. Before rushing to surgery, Dr. Severyn says, “find a physician who has experience, a broad comprehensive perspective, and a lot of treatment resources.” And unless it’s an emergency, get a second opinion before saying yes to back surgery.