Most of us will have an episode of acute back pain in our lives and in some of us, the pain will last for weeks and months. The discomfort is such that you want something done about it and the professionals you see want to help you. Which is why various therapies and interventions are on offer.
A review of the available evidence from randomised trials has looked at the outcomes in people the back pain that’s gone on for at least three months where the cause wasn’t an infection, cancer or say an autoimmune disease. The pain could either be confined to the back or radiating down the leg. The studies involved nearly 8000 people across 13 procedures or combinations of procedures.
Let’s start with people whose pain was confined to the back. Injections of local anaesthetic into the epidural space around the spinal column had little or no effect, nor did epidural local anaesthetic with steroids, epidural steroids by themselves, targeted injections of steroids or local anaesthetic into the joints around the spine. Local anaesthetic injections into the muscles appeared to make the pain worse and trying to destroy the nerves (radiofrequency ablation) to the joints was of little help.
With pain that was going down the leg, the lack of beneficial results was similar, including one targeted at the roots of the nerves in the spine called radiofrequency dorsal root ganglion which tries to change the way the nerves transmit their messages.
It is possible that there are small groups of people who will benefit from one or another of these procedures, but the research wasn’t able to identify who they might be. The problem for the person with chronic back pain is that these interventions are not harm free, may involve travel to a specialist centre and cost you a lot of money. The risks include worsening pain, nerve damage and infection.
Yes, it’s frustrating but the thing to be aware of is that this isn’t the first study to show that these injections don’t work, yet they continue to be offered.
So what does work? Well in many people the pain will go after a few months no matter what you do, including spinal surgery which has doubtful evidence of benefit in most people. There is some evidence that Pilates and the McKenzie method from well-trained clinicians can help restore function and reduce pain and at the very least keep you in some shape to assist with recovery. Opioid pain killers do not help chronic pain and can be disastrous if they cause addiction.
