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. After careful consideration, the panel concluded that there was no high certainty evidence for any procedure or combination of procedures, and all low and moderate certainty evidence suggests no meaningful relief for either axial pain (in a specific area of the spine) or radicular pain (radiating from the spine to the arms or legs) for spine injections compared with sham procedures. As such, they strongly recommend against their use.

This includes injections of local anesthetic, steroids, or their combination; epidural injections of local anesthetic, steroids, or their combination; and radiofrequency ablation with or without local anesthetic plus steroid injections. The panel added that these procedures are costly, a burden on patients, and carry a small risk of harm. As such, they say almost all informed patients would choose to avoid them.

Finally, they acknowledge that further research is warranted and may alter future recommendations, in particular for procedures currently supported by only low or very low certainty evidence of effectiveness. Further research is also needed to establish the effects of interventional procedures on important outcomes for patients such as opioid use, return to work, and sleep quality. In a linked editorial, Jane Ballantyne at the University of Washington says the question this recommendation raises are whether it is reasonable to continue to offer these procedures to people with chronic back pain.

Chiropractic care can provide relief of low back pain without injections or other unproven interventions.

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