A new study from McMaster University suggests that many widely used procedures for chronic spine pain may be ineffective when compared to placebo treatments (sham procedures). The findings, published in The BMJ, raise concerns about the continued use of these treatments despite their high cost, inconvenience, and limited benefits.
The Reality of Chronic Spine Pain
Chronic spine pain, defined as persistent pain lasting three months or longer, is a major global health issue. It affects millions of people and has significant economic and personal consequences. Many patients turn to interventional procedures such as:
- Epidural steroid injections
- Nerve blocks
- Radiofrequency nerve ablation
These treatments are widely performed, yet medical guidelines have given conflicting recommendations about their effectiveness.
What the Study Found
Researchers conducted a comprehensive review of 132 studies, narrowing their analysis to 81 trials involving nearly 8,000 patients. Participants were randomized to receive either real procedures or placebo (sham) treatments to see whether the procedures provided actual pain relief.
The key findings include:
For Chronic Axial Spine Pain (Pain in the Spine Itself)
- Epidural injections (local anesthetic, with or without steroids) and joint-targeted steroid injections provided little to no pain relief when compared to sham procedures (moderate certainty evidence).
- Intramuscular injections (local anesthetic, with or without steroids) also had minimal effects (low certainty evidence).
- One surprising finding: Intramuscular injections of local anesthetic with steroids may actually increase pain.
For Chronic Radicular Spine Pain (Pain Radiating from the Spine, Such as Sciatica)
- Epidural injections of local anesthetic and steroids and radiofrequency of the dorsal root ganglion were unlikely to relieve pain (moderate certainty evidence).
- Other epidural injections (local anesthetic or steroids alone) had minimal impact (low certainty evidence).
For Physical Functioning
- Joint-targeted injections and epidural injections (local anesthetic or steroids) provided little to no improvement in physical ability (moderate certainty evidence).
Risk of Adverse Effects
- Some procedures, such as joint radiofrequency ablation, may slightly increase the risk of non-serious side effects (low certainty evidence).
What This Means for Patients and Doctors
These findings suggest that many common treatments for chronic spine pain may not be effective, yet they continue to be used widely. Given their high cost, risks, and the false hope they offer to patients, the study raises questions about why they remain common practice.
If these results are valid, it may point to a major communication gap between healthcare providers and patientsregarding what these procedures can realistically achieve.
What’s Next?
This study highlights the need for better treatment options for chronic spine pain. More research is needed to:
- Identify truly effective pain management strategies
- Improve patient education about treatment options
- Reduce unnecessary medical procedures that provide little benefit
For now, patients with chronic spine pain should discuss alternative pain management strategies with their doctors, such as physical therapy, exercise, and other evidence-based treatments that may be more effective in the long run.
The research findings can be found in BMJ.
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