Steroid Injections Don’t Improve Chronic Back Pain, According to New Research

A spinal steroid injection—also known as an epidural injection—may only reduce neck and back pain for a few months, according to a recent review by the American Academy of Neurology (AAN).

Spinal stenosis, a common condition in adults over 60, is caused by the narrowing of the spinal canal. This can cause chronic pain and numbness in the neck and lower back. While steroid or cortisone injections are sometimes used to help control pain, they may not be effective.

According to the AAN review, 26% more people who received spinal steroid injections had reduced disability for up to three months compared to those who didn’t. However, the effectiveness waned after three months. The injections reduced pain for 24% more patients for about two to six weeks, but they did not improve function or reduce the need for surgery.

Most of the 90 studies reviewed examined lower back pain rather than neck pain, so it’s unclear how effective spinal steroid injections are for people who have a pinched nerve in the neck—a condition known as cervical radiculopathy.

This review updates a 2007 review of studies on epidural injections, and it confirms previous findings as well, according to Carmel Armon, MD, a co-author of the review and a neurologist at Loma Linda University School of Medicine in California.

“Contrary to the individual impression many patients experience pertaining to immediate alleviation of pain, once one looks at the 3- and 6-month mark, most patients would be in the same place they would be if they received the control treatment, without steroids,” Armon told Verywell.

The study findings should encourage patients to have a conversation with their healthcare providers about their treatment plans, said Mark Bicket, MD, PhD, an anesthesiologist and director of pain and opioid research at Michigan Medicine. 

Bicket said that adding acupuncture after an epidural injection has shown to be effective in some patients with lower back pain, and many people may have already tried physical therapy before seeking more advanced treatment.

Some patients find that epidural injections allow them to have improved mobility, even if the pain isn’t reduced. “And there are people who will get both mobility benefit and pain relief,” Bicket added.

To relieve chronic back pain, medications such as non-steroidal anti-inflammatory drugs (such as ibuprofen) or muscle relaxants help manage symptoms. People who need more advanced treatment may need to undergo a surgery that involves removing all or parts of a disc and/or vertebra to widen the space where the nerve roots exit the spine.