The conclusions we can draw from this study to guide future treatments are severely limited by the use of anesthetic injections in the control group. In other words, this study cannot show that either treatment is no better than injecting nothing at all
Scottsdale, AZ. July 5, 2014 (PRWEB) July 08, 2014
Dr. Paul Lynch, M.D., co-founder of Arizona Pain, the Premier Pain Management Clinic in the Phoenix area, (http://www.arizonapain.com), has responded to recent reports of a study concerning the efficacy of epidural steroid injections for back pain.
The study, published by Dr. Janna Friedly in the New England Journal of Medicine, examined the use of epidural steroid injections for moderate to severe central canal spinal stenosis (1). Lynch calls the study “incredibly flawed,” and believes that it may lead to denial of care for many people that suffer from low back pain.
“There are several points that I would like to address concerning this study,” says Dr. Lynch.
“The study examined the use of epidural steroid injections for the specific condition of moderate to severe central canal spinal stenosis, which is a severe diagnosis. Patients with this condition are typically not the best candidate for epidural injections, and many patients with this condition need surgery. We typically do epidural steroid injections for conditions other than severe spinal stenosis – such as bulging discs or some other disc pathology, before surgery is necessary,” he adds.
In the study, Dr. Friedly chose to use lidocaine as the ‘control’ substance for her injections.
According to Lynch, it has been established for many years that injecting lidocaine into the epidural space can decrease pain by washing out inflammatory mediators.
“When epidural injections were first invented by anesthesiologists, it was done with lidocaine only, as they found this could make sciatica go away,” says Lynch. “Years later, research suggested that mixing steroids with lidocaine was more effective. Either way, this study shows that epidural injections are efficacious whether done with injecting steroid or lidocaine and steroid.”
According to Dr. Ted Swing, Research Director at Arizona Pain, anesthetic injections without steroids were the standard treatment for this type of back pain until the 1950s, when steroid injections became the preferred treatment. Dr. Swing suggested that comparing two potentially helpful treatments “might reveal if one treatment is better than the other, but cannot be used to justify the conclusion that one or both treatments were ineffective.”
“The conclusions we can draw from this study to guide future treatments are severely limited by the use of anesthetic injections in the control group. In other words, this study cannot show that either treatment is no better than injecting nothing at all,” says Swing.
Dr. Swing went on to say the study did find that epidural steroid injections resulted in a 27% reduction in disability and a 39% reduction in leg pain after 6 weeks, compared to a 20% reduction in disability and 36% reduction in leg pain for anesthetic injections.
“These are potentially substantial improvements,” says Swing. “Unsurprisingly, the study found that epidural steroid injections were generally more effective than anesthetic injections, though the depending on the time point and outcome examined, this difference did not always reach statistical significance,” add Swing.
Patients receiving the injections also reported greater satisfaction with their treatment than those receiving anesthetic injections alone. Friedly’s study also showed that the average pain actually decreased from 7.3 to 4.0 in the group that got steroids in addition to lidocaine.
Dr. Tory McJunkin, Lynch’s co-founding partner at Arizona Pain, also weighed in on the study, saying “I have a lot of patients that would love to see their pain go from 7.3 to a 4,” he says. “However, seventy-five percent of the patients in this study received interlaminar injections instead of transforaminal injections, even though the literature is very clear that transforaminal injections work better – and this has been proven in multiple large trials,” he states.
McJunkin also points out that this study involved only one or two injections instead of the recommended series of three performed in the interlaminar space (when transforaminal is recommended); Yet, the study still showed almost 50% pain relief.
Dr. Lynch suggests that the final problem with this study concerns the possibility of insurance companies using this case to deny care to patients who actually need an epidural steroid injection.
“I'm shocked it was published in the first place and more shocked at the media’s spin on the story thus far,” says Dr. Lynch. “When a patient is a qualified candidate for an epidural steroid injection, comprehensive care should be provided in addition,” says Dr. Lynch. “For those who do not qualify for an epidural steroid injection, or for those who prefer not to receive one, we offer numerous other comprehensive and alternative treatment options that are highly effective for treating chronic back pain as well, and we have seen great success with the most severe cases of chronic back pain.”
For more information on Arizona Pain’s many treatments for chronic pain, visit ArizonaPain.com
About Arizona Pain:
The team at Arizona Pain works together to provide relief for various types of chronic pain – including back, neck, facial, joint, hip, and cancer pain, as well as other ailments. These specialists work with one mission in mind: “To change lives by delivering world-class pain management care that we would want for our own mom and dad.” Dr. Tory McJunkin and Dr. Paul Lynch founded Arizona Pain to specialize in pain medicine after a close family member battled severe pain. Arizona Pain remains passionate about treating those who suffer from chronic pain – with the ultimate goal of providing hope and restoring life. For more information on Arizona Pain, or to make an appointment to see one of Arizona Pain's top Pain Management Specialists, visit: http://www.ArizonaPain.com
1. Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med.2014 Jul 3;371:11-21. doi: 10.1056/NEJMoa1313265) http://www.nejm.org/doi/full/10.1056/NEJMoa1313265