Single glucocorticoid injection relieves chronic low back pain short-term

At one month, chronic low back pain associated with active discopathy was reduced in patients treated with a single intradiscal glucocorticoid; however, the effect diminished over time, according to randomized trial results published in Annals of Internal Medicine.

“Chronic low back pain is a common cause of long-term disability,” Christelle Nguyen, MD, PhD, from Sorbonne Paris Cité in France, and colleagues wrote. “Identifying subgroups of patients with specific causative lesions who could benefit from targeted therapies is challenging.”

Previous studies support evaluating treatments that target local inflammation, such as glucocorticoid intradiscal injection; however, “large high-quality clinical trials assessing the short-term efficacy of [glucocorticoid intradiscal injection] in patients with chronic [low back pain] with active discopathy are lacking,” they added.

Nguyen and colleagues performed a prospective, parallel-group, double-blind, randomized, controlled study at three tertiary care centers in France to evaluate the efficiency of a single glucocorticoid intradiscal injection (25 mg prednisolone acetate) in 135 patients with chronic low back pain with active discopathy on magnetic resonance imaging (MRI). The researchers compared the efficacy of a single glucocorticoid intradiscal injection during discography (n = 67) with discography alone (n = 68) for pain intensity at one month. Pain intensity was measured on an 11-point numerical scale ranging from 0 (no pain) to 100 (maximum pain) in 10-point increments. Participants reported the severity of their low back pain 48 hours prior to intervention and at one, three, six and 12 months. The proportion of patients with low back pain intensity less than 40 in the previous 48 hours at 1 month after the intervention was the primary outcome.

Data showed that more patients treated with a single glucocorticoid intradiscal injection indicated a low back pain intensity of less than 40 than those in the control group at one month after intervention (55.4% vs. 33.3%; absolute risk difference, 22.1 percentage points [95% CI, 5.5 to 38.7 percentage points]; P = 0.009). At 12 months, there was no difference in low back pain intensity between the treatment group and control group. In addition, persistent active discopathy on MRI at 12 months, spine-specific limitations in activities, health-related quality of life, anxiety and depression, employment status and use of analgesics and nonsteroidal anti-inflammatory drugs at one and 12 months were not statistically difference between groups.

“The efficacy of [glucocorticoid intradiscal injection] as a possible treatment for chronic [low back pain] associated with active discopathy is questionable, given the lack of long-term benefit,” Nguyen and colleagues concluded.

In a related editorial, David J. Kennedy, MD, from Stanford University, and Bryon J. Schneider, MD, from Vanderbilt University, wrote that Nguyen and colleagues conducted a strong study, as it analyzed a specific treatment for a specific cause of low back pain.

“Unfortunately, much low back pain research inappropriately examines mean outcomes in a heterogeneous group of patients receiving heterogeneous treatments,” they concluded. “We believe that more granularity is required to determine which treatment is right for which patients. Nguyen and colleagues have made progress in this regard, but more work is required.” – by Alaina Tedesco

Disclosure: Nguyen and colleagues report receiving primary funding from the French Ministry of Health. Kennedy and Schneider report no relevant financial disclosures.