Epidural Steroid Injections for Pain Likely Have Limited Efficacy Among Older Adults

Older adults reported long-term improvement following epidural steroid injections for a new episode of back pain; however, the improvement was likely not related to the effect of the injections, according to the results of a study published in the European Journal of Pain.

A team of investigators enrolled patients presenting to Kaiser Permanente Northern California, Henry Ford Health System, and Harvard Vanguard Medical Associates for management of new episodes of back pain in their study evaluating the long-term effectiveness of epidural steroid injections for new-onset low back pain. Outcomes up to 24 months were evaluated on the basis of whether the patient received epidural steroid injections (n=295) or not (n=4809) using a propensity-matching approach.

The mean ages of patients in the treatment and no-treatment cohorts were 74.1 (standard deviation [SD], 6.8) and 73.8 (SD, 6.9) years, respectively; 63.7% and 64.9% were women, 74.6% and 73.1% were White, numeric rating scale scores for back pain were 6.1 (SD, 2.8) and 5.0 (SD, 2.8), Roland-Morris Disability Questionnaire (RMDQ) scores were 13.0 (SD, 5.7) and 9.3 (SD, 6.4), EuroQol-5D scores were 0.66 (SD, 0.20) and 0.76 (SD, 0.17), and 86.8% and 61.6% had leg pain.

Patients who received epidural steroid injections within 6 months of the baseline visit reported worse back pain intensity (β, 1.1; P <.001) and leg pain intensity (β, 2.4; P <.001), RMDQ (β, 3.4; P <.001), as well as worse scores on the EuroQol-5D (β, -0.091; P <.001).

In general, back and leg pain, RMDQ scores, and EuroQol-5D scores improved among both groups over time.

Among a propensity-matched cohort of 285 patients who received epidural steroid injections and 483 who did not, the posttreatment trajectories of change in back and leg pain, RMDQ score, and EuroQol-5D score did not differ at any time point, and no treatment-by-time interactions were observed.

A major limitation of this study was the lack of randomization and blinding.

Study authors conclude that among older adults with a new episode of back pain, recipients of epidural steroid injections were unlikely to experience long-term benefits. They comment, “Health care professionals may consider informing patients that they can improve in the long term, independent of the use of [epidural steroid injections].”