What we know about the recommendation for an injection is that most of the time, this is based off of what is seen on imaging. If a bulging disc is seen on imaging and a patient is complaining of back pain, many times an injection will be recommended. I have seen many people who have had multiple injections already with no benefit or only temporary relief. The reason for this is something that I have discussed previously. In many of us (even without back pain), if we had an MRI on our backs, it would show a bulging disc. www.promotiongb.com/blog/low-back-imaging-how-useful-is-it. Because of this, we have to question if the disc is really the source of the pain. Most of the time it is not. Therefore, having an injection to "correct" this problem is likely not going to help and many people are left frustrated by the lack of improvement following an injection, or multiple injections.
Now, don't get me wrong. there are times when a person will feel benefit from an injection. Maybe you have, or you know if someone who has. When we review the research on this, we find that it may not really be the steroid that is helping with back pain, but more the procedure itself. In studies that compare people who receive an injection consisting of steroids with those that receive an injection of saline (basically salt water or a "fake" steroid injection), there is no difference in the outcomes-a similar percentage of people benefit from the fake injection as those that get the real injection. So, just the process of receiving a procedure that the patient, and clinician performing it, think will help, actually helps. The problem with this is that the benefits are usually not long-lasting and patients need to keep going back for more, without improvement in their function (ability to do things they want).
So far, I have only discussed injections for back pain only. There is some research that shows injections might be beneficial in a new onset of back pain with leg pain. You might have heard this called "sciatica" or radiculopathy. Again, this is for a relatively new onset and not leg pain that has been present for a long time. Sometimes, in a new episode, the steroid can help reduce some inflammation around the nerve that is causing the leg pain. But again, even without the injection, most of the time, this will get better on its own.
Still, if the injection for this condition might help reduce some of the current pain a person is feeling and allow them to get moving more and progress in therapy, I will sometimes recommend an injection for this situation.
Why is an injection recommended so much when there is not much evidence to support it for back pain. Well, this is complicated. First, many physicians are not familiar with the research that show how common bulging discs are in people without symptoms, so they attribute many things seen on MRI as the source of a person's pain, when in fact this may not be true. Secondly, injections are good money makers for many health systems. The procedure only takes about 15 minutes and charges are $1500-$2000 depending on where you go. So, as long as it is getting paid, most health systems are not going to stop doing them. Another reason is that patients suffering with back pain just want relief. I understand this. If they are told they need something relatively simple and that it will help, they want it. Unfortunately, for back pain, there is usually not a "quick fix"-particularly the longer you have had it. But, with the right information, some good treatment to help decrease the pain to allow you to get moving, and a bit of work on your part, you can get over back pain and back to living life to the fullest. The key point from this article is that an injection does not have to be, and many times should not be, part of the solution for back pain.
Thanks for reading and feel free to reach out if you have questions,