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Time to reconsider steroid injections in the spine?

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To the Editor: In their review, Harris and Buchbinder call for a ban on all spinal injections of steroids.1 These injections are not a singular procedure; they differ by indications, technique, and the evidence that serves each.

For the treatment of low back pain, no evidence supports the use of epidural steroids, and intra-articular injections of steroids are clearly no more effective than sham therapy.2 Disavowing this treatment is, therefore, justified. Ironically, the treatment with the greatest success rate and longest duration of success for chronic low back pain is injection of normal saline.3

For the treatment of radicular pain, multiple studies have shown that epidural injections of steroids are no more effective than sham treatment.4,5 One study showed marginal superiority over placebo at 3 weeks,6 but by 30 days, the number needed to treat is 100.7 Yet, the Faculty of Pain Medicine still endorses this intervention.8

The evidence is different for transforaminal (TF) injection of…