Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief compared with sham injections, say a panel of international experts in the BMJ. Their strong recommendations apply to procedures such as epidural steroid injections and nerve blocks for people living with chronic back pain (lasting at least 3 months) that is not associated with cancer, infection or inflammatory arthritis.

Their advice is based on the latest evidence and is part of The BMJ’s ‘rapid recommendations’ initiative — to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.

Chronic back pain is the leading cause of disability worldwide. It is estimated to affect 1 in 5 adults aged 20-59, with higher rates likely among older adults. In 2016, low back and neck pain accounted for the highest healthcare spending in the U.S. at $134.5 billion.

Procedures such as epidural steroid injections, nerve blocks and radiofrequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals reaching the brain, but current guidelines provide conflicting recommendations for their use. so, an international panel, made up of clinicians, people living with chronic spine pain, and research methodologists, carried out a detailed analysis of the latest evidence. This evidence, based on reviews of randomized trials and observational studies, compared the benefits and harms of 13 common interventional procedures, or combinations of procedures, for chronic, non-cancer spine pain against sham procedures.

Hands-on, opioid free chiropractic care by professionally trained expert chiropractors is a proven approach to low back pain.

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