DEAR DOCTOR K:
I have spinal stenosis. Will steroid shots help with pain relief?
Spinal stenosis is a narrowing of the open space in the spinal canal. This squeezes nerves, causing pain in the lower back, buttocks and legs. I have spinal stenosis, so I know about it both as a physician and a patient.
Medicines and physical therapy are usually the first treatments for spinal stenosis pain. If these treatments don’t work, doctors often recommend spinal injections.
Spinal injections generally include a corticosteroid to reduce swelling and inflammation and a local anesthetic, such as lidocaine, to numb the area. Most doctors consider the injections to be safe as long as proper precautions are taken and the injections aren’t repeated too often.
But a new study calls into question just how good these injections are for spinal stenosis. The study included 400 people with back and leg pain from spinal stenosis. They were randomly divided into two groups. One group received either one or two injections that contained a steroid plus lidocaine. The other group got injections of lidocaine only. Lidocaine is a short-acting anesthetic that would not be expected to provide lasting relief.
Six weeks later, there were no differences between the groups in their levels of pain or function. People in both groups reported improvement, but those who received both drugs did not report any more improvement than those who received lidocaine alone.
This study has made me much less likely to recommend spinal injections of corticosteroids for lower back spinal stenosis. The greatest danger is infection. There are other conditions that cause low back pain, however, where spinal injections of corticosteroids may have some value.
More research is clearly needed. A larger study might be able to tease out whether certain groups of people might be more likely to benefit from spinal injections. All we know from any randomized trial, even well-done studies like this one, is what the reaction to the treatment has been for the average patient in the study. It remains possible that one subgroup of patients in the study — those with more severe narrowing of the spinal canal, for example — might really benefit from the treatment.
You can also try:
- Analgesics, such as acetaminophen (Tylenol)
- Anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Muscle relaxants
- Physical therapy or stretching
If all else fails, you might need to consider surgery. This is a major operation that is usually regarded as a last resort.
As for me, I have been fortunate. Regular exercises to strengthen my back muscles have kept me nearly completely free of symptoms. That also has been my experience with patients. Very few have needed to consider surgery, and relatively few have received spinal injections of corticosteroids.
What if that does not remain true and my symptoms return? And what if all the other treatments I’ve mentioned (short of surgery) don’t give relief? Would I consider spinal injections of corticosteroids? Yes, I might. But I wouldn’t be terribly confident that I’d made the right decision.