Cochrane reviews injection therapy for low back pain
The reviewers conclude, “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain.”
First, the details.
- 18 studies of injection therapy in 1179 participants involving epidural, facet, or local sites for subacute or chronic low-back pain were included in the review.
- 2 reviewers independently assessed the quality of the studies.
- The results were reanalyzed (meta-analysis) where possible.
- Studies of intradiscal injections, prolotherapy, or ozone therapy with other treatments, were excluded unless injection therapy with another pharmaceutical agent (no placebo treatment) was part of one of the treatment.
- Studies about injections in sacroiliac joints and studies evaluating the effects of epidural steroids for radicular pain were also excluded.
And, the results.
- There was no strong evidence for or against any type of injection therapy.
- Injection sites varied from epidural sites and facet joints (intra-articular injections, peri-articular injections and nerve blocks) to local sites (tender- and trigger points).
- Drugs studied included corticosteroids, local anesthetics, and other drugs.
- 10 out of 18 trials were well designed.
The bottom line?
OK, lack of evidence of effect is not necessarily evidence of lack of effect.
But after studying more than 1100 people, we might hope for more direction.
7/28/08 16:14 JR