'Salt' jab may treat lower back pain

A saline injection in the spine may be more effective than steroids for treating lower back pain, scientists, including one of Indian-origin, have claimed.
Researchers from Johns Hopkins University suggest that it may not be the steroids in spinal shots that provide relief from lower back pain, but the mere introduction of any of a number of fluids, such as anesthetics and saline, to the space around the spinal cord.
For decades, epidural steroid injections have been the most common nonsurgical treatment for lower back pain even though extensive research shows mixed results.
Steroids are a less-than-ideal treatment for some as they can raise blood sugar in diabetic back patients, slow wound healing in those who need surgery and accelerate bone disease in older women.

Johns Hopkins anesthesiologist Steven P Cohen and his colleagues reviewed dozens of published studies on the subject.
As expected, they found that epidural steroid shots were more than twice as likely to bring relief as injections of steroids, saline or a local anesthetic like Lidocaine into muscle near the spinal canal.

However, they also found that epidural injections of any kind were also twice as good as intramuscular injections of steroids.
"Just injecting liquid into the epidural space appears to work. This shows us that most of the relief may not be from the steroid, which everyone worries about," Cohen said.

Cohen said concerns increased last year when more than 740 people in 20 US states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids made by a compounding pharmacy.
Although better oversight might allay that concern, Cohen noted that patients can only get a limited number of steroid injections each year, even if their pain returns.
Cohen cautioned that it is too soon to recommend that patients stop receiving epidural steroids, but added that their analysis also suggests that smaller steroid doses can be just as beneficial.
"Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable," said Mark C Bicket, from The Johns Hopkins Hospital, and the study's first author.

The Johns Hopkins review covered medical records of 3,641 patients from 43 studies conducted through October 2012. The studies compared epidural steroid injections to other sorts of epidural and intramuscular injections.
Charlie H Brown IV and Anita Gupta of Johns Hopkins also contributed to the research that will appear in the journal Anesthesiology.