A narrative review of intra-articular corticosteroid injections for low back pain.
OBJECTIVE
To summarize and to analyze the available literature on the efficacy of intra-articular injections of corticosteroids for low back pain.


METHODS
Publications, in English, French, and German, were obtained that reported the proportions of patients who obtained complete relief of pain following intra-articular steroids, and that provided any form of follow-up. These publications were analyzed to determine the rationale, indications, and outcomes of the treatment.


RESULTS
The only rationale for intra-articular steroids appears to be the expectation that they should work. The most commonly used indication has been back pain, for which no specific diagnosis has been made. When the results of observational studies are pooled, they paint a picture of impressive immediate responses, but a rapid decay of outcomes by three and six months. Initial responses, however, are dissonant with the literature from controlled studies of the prevalence of lumbar zygapophysial joint pain. Moreover, controlled trials have shown that there is no attributable effect to the injection of steroids.


CONCLUSIONS
The apparent efficacy of lumbar intra-articular steroids is no greater than that of a sham injection. There is no justification for the continued use of this intervention. Better outcomes can be achieved with deliberate placebo therapy.
Bogduk
Nikolai
N
Department of Clinical Research, University of Newcastle, Royal Newcastle Hospital, Newcastle, New South Wales, Australia. mgillam@mail.newcastleedu.au
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D006801:Humans; D007268:Injections, Epidural; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region; D021801:Zygapophyseal Joint / Q000187:drug effects
D000305:Adrenal Cortex Hormones