Loading ...From Medscape, 11/1/11…
Recently in the British Medical Journal, there was a very interesting randomized study for the treatment of chronic low back pain that was performed in Norway.[1] The investigators recruited 116 patients with chronic low back pain and randomly assigned them into 3 groups. The active treatment group received epidural injections of cortisone; the control group received 30-mL epidural injections of saline; and the third group received a sham treatment of 2 mL saline injected subcutaneously. This was a severely disabled group of patients. The majority of patients were men and, on average, they had between 64 and 160 weeks of chronic low back pain. They had an average of 32-37 weeks of absence from work because of low back pain. The primary endpoint of this study was the Oswestry Disability Index score, which measures the impact of low back pain. The secondary endpoints were scale scores for back pain and leg pain, and the investigators also used quality-of-life measurements. Endpoints were measured at 6, 12, and 52 weeks.
As it turned out, there was no difference between the 3 treatment groups. This was true for all timepoints. All patients improved, but the epidural injection of prednisone did not lead to a better improvement than, for example, a sham injection. This study is very important when we talk to our patients who have low back pain. I think we can tell them that this invasive procedure is not better than placebo treatment. Our advice should be to stay with conservative treatments like regular exercise, physical therapy, and if necessary intake of nonsteroidal anti-inflammatory drugs and behavioral therapy.
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