Back pain: no to steroids

The latest fad for chronic low back pain namely injecting steroids into the facet joints has just been proved useless.

Researchers writing in the New England Journal of Medicine conducting fastidious and long term follow up of patients injected with steroid treatment found, in the words of an accompanying editorial, that the treatment was "overused and minimally effective."

The editorial said that this latest treatment follows a long history of faddish treatments for this problem fusing the sacroiliac, removing the coccyx, electrical nerve stimulation which all in time have been abandoned.

To avoid more faddish approaches, the editorial called for practice to be "based more firmly on the results of rigorous outcomes research, and less on seductive theories."

The author, Dr Richard Deyo of the Veterans Affairs Medical Center in Seattle, Washington, also says that in too many cases investigators have vested interests in favourable results. "Too much research on back problems consists of case series that serve the entrepreneurial purpose of legitimizing expensive new forms of technology, rehabilitation centers or surgical programmes of uncertain effectiveness," he writes.