A controlled trial of corticosteroid injections into facet joints for chronic low back pain

Article Abstract:

Chronic low back pain can be debilitating for the patient, and the condition takes an enormous toll in the United States both in terms of suffering and cost. Over the years, many different treatments have been advocated, but many have proved to be little more than fads without any proven medical benefit. A major breakthrough in the understanding of low back pain occurred in the 1960s when it was demonstrated that the facet joints of the individual vertebrae in the spine play an important role in low back pain in some patients. Today it is common practice to inject steroid drugs into the facet joints to alleviate low back pain. Unfortunately, this treatment, like many others previously used, is unsubstantiated by careful scientific evaluation. To determine if the injection of corticosteroids into these joints is actually effective, a study was conducted involving 97 patients with chronic low back pain. Forty-nine of these patients were randomly assigned to receive injections of the steroid drug methylprednisolone, while the remaining 48 received injections of saline. Forty-two percent of the patients receiving steroid injections reported marked improvement in their back pain. Thirty-three percent of the patients receiving only saline injections reported similar levels of improvement. This difference in patients reporting improvement is not statistically significant. Similarly, evaluation of pain, functional status, and the ability to flex the back revealed no differences between the patients who received steroid drugs and those who received only saline. Steroid injection into the facet joints is used widely in North America. Fortunately, the treatment appears to be safe. Unfortunately, the evidence suggests that it is ineffective as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Corticosteroids, Adrenocortical hormones, Backache, Back pain

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Laparoscopic surgery in infertile women with minimal or mild endometriosis

Article Abstract:

Laparoscopic surgery appears to restore fertility in many women with mild endometriosis. Endometriosis occurs when blood from the uterus backs up into the Fallopian tubes and gets on the ovaries and other organs outside the uterus. Researchers randomly assigned 341 infertile women with mild endometriosis to receive laparoscopic surgery involving ablation or resection or to receive diagnostic laparoscopy only. Thirty-one percent of the women who had surgery eventually got pregnant compared to 18% of those who did not. Three women who had surgery developed minor complications from the surgery.

Surgery, Endometriosis, Laparoscopic surgery, Infertility, Female, Female infertility

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Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus

Article Abstract:

Corticosteroid injections do not appear to benefit patients with sciatica due to a herniated disk. Researchers gave as many as three spinal injections of methylprednisolone or placebo to 158 patients with sciatica caused by a herniated disk. Although methylprednisolone improved some symptoms during the first three weeks, by three months there were no significant differences in pain relief or other symptoms between the two groups. The rates of surgery were also equivalent in both groups.

Sciatica, Injections, Spinal, Spinal injections

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