An international panel of experts has issued a strong recommendation against the use of spinal injections for managing chronic back pain. According to their analysis, these procedures offer little to no relief compared to placebo treatments. This advice pertains specifically to interventions like epidural steroid injections and nerve blocks for non-cancer-related chronic back pain lasting at least three months. The panel's guidance is part of an initiative by The BMJ aimed at providing rapid, evidence-based recommendations to assist healthcare providers in making informed decisions with their patients.

Chronic back pain stands as a leading cause of disability globally, affecting approximately one in five adults aged 20-59, with higher prevalence among older individuals. In 2016 alone, the United States spent $134.5 billion on low back and neck pain treatments. Despite this, there remains significant uncertainty about the efficacy of invasive procedures such as spinal injections. To address this, an international team comprising clinicians, patients, and research methodologists conducted a thorough review using the GRADE approach, a system designed to evaluate the quality of medical evidence.

Their findings revealed that none of the 13 common interventional procedures evaluated provided substantial pain relief when compared to sham treatments. Procedures ranging from local anesthetic and steroid injections to radiofrequency ablation were scrutinized. The panel concluded that all available evidence, whether of low or moderate certainty, failed to demonstrate meaningful benefits for either localized or radiating pain. Moreover, these treatments are not only expensive but also pose potential risks, leading the experts to strongly advise against their use.

Patient-centered considerations played a crucial role in the panel’s decision. They noted that most well-informed patients would likely opt out of these costly and potentially harmful procedures. While acknowledging the need for further research, especially for interventions supported by limited evidence, the panel emphasized the importance of exploring alternative approaches to chronic pain management. This includes focusing on non-procedural treatments that might offer better outcomes in terms of reducing opioid dependency, improving work reintegration, and enhancing sleep quality.

This development underscores a growing consensus that the management of chronic pain requires a fundamental shift, possibly through rebalancing the focus between procedural and non-procedural treatments. As healthcare systems reassess their funding priorities, the emphasis may increasingly shift towards more effective and less invasive methods of addressing chronic back pain.