A group of international experts has strongly advised against using spine injections for adults with long-term back pain. Their recommendation, published in The BMJ, is based on recent studies showing that these injections offer little or no relief compared to fake (sham) injections.
The procedures in question include epidural steroid injections and nerve blocks. The advice applies to people who have had back pain for at least three months, as long as it is not caused by cancer, infection, or inflammatory arthritis.
This recommendation is part of The BMJ’s “Rapid Recommendations” project, which quickly provides trustworthy medical guidance based on the latest research. The goal is to help doctors and patients make better decisions.
Chronic Back Pain and Its Costs
Chronic back pain is one of the leading causes of disability worldwide. It affects about one in five adults aged 20 to 59, with even higher rates among older people. In 2016, back and neck pain accounted for the highest healthcare spending in the U.S., costing about $134.5 billion.
Many people with chronic back pain receive treatments such as epidural steroid injections, nerve blocks, and radiofrequency ablation (a procedure that uses radio waves to damage nerves and block pain signals). However, medical guidelines do not agree on whether these treatments work.
What the Research Found
To settle this issue, an international panel of doctors, researchers, and people with chronic back pain reviewed the latest evidence. They used a system called the GRADE approach, which helps assess the quality of medical studies.
Their review included data from randomized trials and observational studies. They compared 13 common spine procedures to fake treatments (sham procedures) to see if they provided real pain relief.
After analyzing the results, the experts found no strong evidence that any of these injections or procedures provided meaningful relief. The studies with lower-quality evidence also suggested little to no benefit. This was true for both axial pain (pain in one area of the spine) and radicular pain (pain that spreads from the spine to the arms or legs).
Because of these findings, the experts strongly recommend against the use of:
- Local anesthetic injections
- Steroid injections
- A combination of anesthetics and steroids
- Epidural injections of anesthetics, steroids, or both
- Radiofrequency ablation with or without injections
Why Experts Say These Injections Should Be Avoided
The panel explained that these procedures are expensive, inconvenient for patients, and come with small risks. Since they provide little or no real benefit, most well-informed patients would likely choose to avoid them.
However, the experts acknowledged that more research is needed. Future studies could change these recommendations, especially for procedures where the current evidence is weak. Researchers also need to explore other important factors, such as whether these treatments reduce opioid use, help people return to work, or improve sleep quality.
What This Means for the Future of Pain Treatment
In a related editorial, Dr. Jane Ballantyne from the University of Washington questioned whether doctors should continue offering these injections at all.
She noted that changing long-standing medical practices is difficult. However, as more research shows these injections do not work, health systems may stop covering them.
Dr. Ballantyne concluded that this is not the final word on spine injections.
However, she believes chronic pain treatment needs a major overhaul. Instead of focusing on expensive procedures, healthcare should offer better support for non-invasive pain management options.
If you care about pain, please read studies about vitamin K deficiency linked to hip fractures in old people, and these vitamins could help reduce bone fracture risk.
For more information about wellness, please see recent studies that Krill oil could improve muscle health in older people, and eating yogurt linked to lower frailty in older people.
The research findings can be found in The BMJ.
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