An article published in the July 3, 2014 issue of  The New England Journal of Medicine caught my eye.

A double-blind and randomized study was conducted in which patients with lumbar central spinal stenosis and moderate-to-severe leg pain and disability were given either epidural lidocaine injections or epidural injections with both lidocaine and steroids.

[note: Randomized Double-Blind trials are the best, most accurate form of clinical research in which neither the doctors nor the patients know which treatment they are receiving. The only way to improve upon this format is to offer a placebo as well as one of the treatment options.]

The simple lidocaine injections were found to be, at least statistically, just as effective as the more costly and risky combination steroid containing epidural injections.

This is a game-changer for me as I routinely send this type of patient for epidural injections if they fail to achieve their desired improvement from my evidence-based treatment protocol for this condition.

25% of the epidural glucocorticoid (steroid) injections given in the USA to those aged 65 and older are for spinal stenosis.

Epidural injections are (moderately) risky, somewhat painful and always costly. The steroids used have been linked to increases in spinal fractures as well as other unsavory outcomes. Even still, for many patients with low back pain and the symptoms of stenosis, epidural injections have shown themselves to be helpful.

Perhaps we need to reevaluate the 9 million injections that are being given each year.

A large number of these patients are unlikely to have received an evidence-based functional rehabilitation program let alone chiropractic care. We can help a larger number of patients with stenosis live a more functional and pain-free life if we utilize the least invasive methods of treatment before resorting to epidural injections.

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