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. www.promotiongb.com/blog/what-happens-to-herniated-discs 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, Bob
6 Comments
8/20/2019 12:54:22 pm
You made a good point that people with a bulging disc in imaging is often recommended for injection. I've recently had a lot of back pain and haven't been able to adequately manage it. Maybe I should look into interventional injections services and see if that can give me some relief.
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Bob Brady
12/3/2019 04:21:28 pm
Hi Tom,
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3/29/2022 10:40:21 am
It's great that you elaborated that one of the more common recommendations by physicians for the treatment of back is steroid injections. My grandfather is already 90 years old and he has a lot of medications. Being hard to walk I suggested avail of the services of the home care it will be more convenient on my grandfather's side.
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5/2/2022 12:14:51 am
My friend saw a couple of flyers that offer steroid supplements and it got him curious. It's amazing how steroids can help spice up your running performance by treating muscle issues. Maybe we should find a clinic where he could try this out in the future.
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thank you so much for the informative content and helpful for me and this content is very nice and informative. And explain the word by word and help myself. once again thank you so much. I hope you can visit my website and helpful information content yourself. And helpful for advantages people.
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2/19/2023 09:04:28 pm
I just wanted to say that your article on back pain was excellent. You have a real talent for explaining complex medical issues in a way that is easy to understand. I'll definitely be sharing this with my friends and family who are also dealing with this issue.
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