Injection Therapy for Subacute and Chronic Low Back Pain: An Updated Cochrane Review

  title={Injection Therapy for Subacute and Chronic Low Back Pain: An Updated Cochrane Review},
  author={J. Bart Staal and Rob A. de Bie and Henrica C. W. de Vet and Jan Hildebrandt and Patricia J. Nelemans},
Study Design. A systematic review of randomized controlled trials (RCTs). Objective. To determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low back pain. Summary of Background Data. The effectiveness of injection therapy for low back pain is still debatable. Heterogeneity of target tissue, pharmacological agent, and dosage, generally found in RCTs, point to the need for clinically valid comparisons in a literature synthesis… 
Injection therapy for subacute and chronic low-back pain.
There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain, however, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection Therapy.
Injection therapy and denervation procedures for chronic low-back pain: a systematic review
Overall, there is only low to very low quality evidence to support the use of injection therapy and denervation procedures over placebo or other treatments for patients with chronic LBP, however, it cannot be ruled out that in carefully selected patients, some injection therapy or Denervation procedures may be of benefit.
  • H. Choi, S. Hahn, B. Park
  • Medicine
    International Journal of Technology Assessment in Health Care
  • 2013
A long-term benefit of epidural steroid injections for low back pain was not suggested at 6 months or longer, and introduction of selection bias in the majority of injection studies seems apparent.
Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials.
Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
Intra-articular facet joint injections for low back pain: a systematic review
The positive results, whilst interpreted with caution, do suggest that there is a need for further high-quality work in this area, and a number of methodological issues were identified.
Epidural Injections for Spinal Pain: A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials
Epidural nonsteroid injections may provide improved benefit compared with nonepidural injections on some measures, though few, low-quality studies directly compared controlled treatments, and only short-term outcomes were examined.
Effect of Facet Joint Injection Versus Systemic Steroids in Low Back Pain: A Randomized Controlled Trial
Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.
Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial.
This feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain, and process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly.
Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review.
Overall, the studies showed promising results for the treatment of severe chronic knee pain by radiofrequency ablation at up to one year with minimal complications, but the inconsistent procedural methodology, inconsistent patient assessment measures, and small study sizes limit the applicability of any specific study to clinical practice.
Epidural Steroids: A Comprehensive, Evidence-Based Review
Epidural steroid injections are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews, but there continues to be considerable controversy surrounding their safety and efficacy.


Prolotherapy injections for chronic low-back pain.
There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low-back pain, and in the presence of co-interventions, Prolotherapy injections were more effective than control injections, more so when both injections and co- interventions were controlled concurrently.
Radiofrequency Denervation for Neck and Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group
There is limited evidence that radiofrequency denervation offers short-term relief for chronic neck pain of zygapophysial joint origin and for chronic cervicobrachial pain, and conflicting evidence for its effectiveness for lumbar zygapsial joint pain.
Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial.
The results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work.
Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study.
The efficacy and safety of parenteral Vitamin B12 in alleviating low back pain and related disability and in decreasing the consumption of paracetamol was confirmed in patients with no signs of nutritional deficiency.
A Prospective, Randomized, Double-Blind Evaluation of Trigger-Point Injection Therapy for Low-Back Pain
Trigger-point therapy seems to be a useful adjunct In treatment of low-back strain, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.
Lumbar facet joint syndrome. A randomised clinical trial.
It is concluded that facet joint injection is a non-specific method of treatment and the good results depend on a tendency to spontaneous regression and to the psychosocial aspects of back pain.
A Randomized Clinical Trial of Treatment for Lumbar Segmental Rigidity
A randomized single-blind clinical trial of facet injections plus exercise, versus exercise alone, in chronic disabling work-related lumbar spinal disorders (CDWRLSD), accompanied by pilot interrater reliability and facet syndrome prevalence studies showed significant improvement from pre- to postintervention in pain and disability assessments.
Iliac crest pain syndrome in low back pain. A double blind, randomized study of local injection therapy.
An effect of a local injection with lignocaine that is somewhat larger than an injection with saline which also has some beneficial effect is demonstrated, evident in the rheumatology setting but not in the general practice setting.
Intradiscal Steroids: A Prospective Double‐Blind Clinical Trial
No statistically significant benefit was identified in the use of intradiscal steroids and a pain diagram grid score, a visual analog scale, and the Oswestry Pain Questionnaire were used before injection and 10–14 days after injection.
Capacity of the Clinical Picture to Characterize Low Back Pain Relieved by Facet Joint Anesthesia: Proposed Criteria to Identify Patients With Painful Facet Joints
A set of five clinical characteristics can be used in randomized studies to select lower back pain that will be well relieved by facet joint anesthesia and should not, however, be considered as definite diagnostic criteria of lower backPain originating from facet joints.