PAIN+ CPN

Doctor, I have lower back pain due to a herniated disc. Do injections of pain medications into the back have a lasting effect?

For some people with lumbar disc herniation, injections of lidocaine with or without steroids into their lower back can provide pain relief even after repeated injections over 1 to 2 years.

What is the evidence?

SUMMARY of FINDINGS

Lidocaine plus steroid vs lidocaine alone injections into the lower back

OutcomeLidocaine plus steroidsLidocaine aloneEffect
50% or greater pain relief at 1 year70 out of 100 people65 out of 100 peopleno difference*
50% or greater pain relief at 2 years62 out of 100 people60 out of 100 peopleno difference*

*although the rates for the 2 groups look different, the differences were not statistically significant —this means that the difference could simply be due to chance rather than due to the different treatments



What kind of study was this?

This was a systematic review of 7 randomized controlled studies published up to July 2016.

Who? The studies included 832 people with lumbar disc herniation (protective layer around the outside of the disc is torn so the inside can push through to press on nerves) (5 studies) or lumbar spinal stenosis (narrowing of space around spine which can put pressure on nerves) (2 studies) who were followed for at least 1 year (average age 42 to 57 years old). People who had spinal surgery in the past were excluded.

What? The studies compared lidocaine plus steroid injections with lidocaine injections.

Lidocaine plus steroids

vs

Lidocaine alone

Lidocaine plus steroid injections into the lower back

If people had pain relief after the first injection, additional injections were given when the pain returned (average number of injections 5 over 2 years)

People were allowed to take other pain medications as needed and to participate in physiotherapy or exercise programs


Lidocaine injections into the lower back

If people had pain relief after the first injection, additional injections were given when the pain returned (average number of injections 5 over 2 years)

People were allowed to take other pain medications as needed and to participate in physiotherapy or exercise programs

Why was this research done?

Lumbar disc herniation is a frequent cause of lower back pain. Injections of medications into the back around the spinal cord relieves the pain for some people. The reveiwers wanted to know if injecting lidocaine (an anesthetic drug used to block pain during surgical procedures) alone was as good as lidocaine plus steroid (drugs that reduce inflammation) injections in reducing pain after 1 to 2 years of treatment. They found that both options reduced pain in 70 out of 100 people at 1 year and in 60 out of 100 people at 2 years.

This Evidence Summary is based on the following article:

Zhao W, Wang Y, Wu J, et al. Long-Term Outcomes of Epidurals with Lidocaine With or Without Steroids for Lumbar Disc Herniation and Spinal Stenosis: A Meta-Analysis. Pain Physician. 2020 Jul;23(4):365-374. PubMed

Published: Monday, December 7, 2020
Last Updated: Tuesday, July 13, 2021