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A panel of international experts has issued a strong recommendation against the use of spine injections for chronic back pain, citing little to no significant pain relief compared with sham procedures. The findings, published in The BMJ, emphasize that these injections should not be administered to adults suffering from chronic back pain unrelated to cancer, infection, or inflammatory arthritis.
A Global Health Concern
Chronic back pain remains a leading cause of disability worldwide, affecting one in five adults aged 20–59, with an even higher prevalence among older individuals. In 2016 alone, healthcare spending on low back and neck pain in the U.S. reached a staggering $134.5 billion.
Epidural steroid injections, nerve blocks, and radiofrequency ablation are commonly used to mitigate pain by preventing signals from reaching the brain. However, existing guidelines on their effectiveness are conflicting, prompting a detailed review by an international panel consisting of clinicians, chronic pain patients, and research methodologists.
No Meaningful Pain Relief
Using the GRADE approach—a widely accepted system for assessing the quality of evidence—the panel analyzed data from randomized trials and observational studies. They compared 13 common interventional procedures for chronic, non-cancer spine pain against sham treatments.
The results were clear: none of the reviewed procedures provided high-certainty evidence of meaningful pain relief. Low to moderate certainty evidence suggested no significant improvement for axial pain (localized pain in the spine) or radicular pain (pain radiating to the arms or legs) when compared to placebo treatments.
Risks and Costs Outweigh Benefits
Based on these findings, the panel strongly advised against procedures involving injections of local anesthetics, steroids, or their combinations, as well as radiofrequency ablation treatments. They noted that these interventions are costly, burdensome for patients, and carry small but notable risks of harm. Consequently, they concluded that most well-informed patients would likely opt against undergoing these procedures.
Calls for a Paradigm Shift in Pain Management
The panel acknowledged that further research is necessary to refine treatment guidelines and determine the impact of interventional procedures on critical patient outcomes, such as opioid use, sleep quality, and return to work.
In a linked editorial, Jane Ballantyne of the University of Washington questioned whether healthcare providers should continue offering these treatments given the mounting evidence against their efficacy. She emphasized the need for a fundamental shift in chronic pain management, arguing for a better balance between procedural and non-procedural treatment options.
“This will not be the last word on spine injections for chronic back pain,” Ballantyne wrote. “But it adds to a growing sense that chronic pain management needs a major rethink.”
Disclaimer
This article is based on current research and expert recommendations but should not be taken as medical advice. Patients should consult their healthcare providers before making decisions regarding their treatment options.
