Letter to the Editor: Steroid injections and back pain

The United Kingdom National Institute for Health and Clinical Excellence (NICE) advises against offering any injections of therapeutic substances for persistent low back pain based upon a systematic review of the best available evidence.1

The evidence for steroid injections is that they provide no, or at best minimal, short-term benefit for just two conditions that involve the back: spinal canal stenosis and sciatica.2–4

It should be noted that the response to steroid injections in these studies is equal to or little better than the response seen in placebo groups. The treatment benefits suggested in the article (“Hugely helpful in the management of lumbar pain”, “90% reduction in symptoms”) are at odds with the best scientific evidence regarding the true effectiveness of spinal steroid injections.

Most patients with back pain have non-specific back pain and here the situation is very clear: there