Do Injections Even Work for Back Pain?

To the Pain
To the Pain (Photo credit: Wikipedia)

The New York Times Magazine published an article last week talking about the escalating use of injections for chronic low back pain. Anyone with pain anywhere had probably been offered an injection at this point. Placing an anesthetic into the joint does help with short term pain, and is very good for a doctor’s bottom line.

But does it really help with the back pain over the long term more than taking oral pain medication? The newer studies are saying no.

In fact, the injections might be making you worse. A Spine study published in February found that patients who had been receiving injections had a longer surgery and a longer hospital stay once they did get back surgery. They also did worse in terms of back pain than those who did not receive the injections.

The NYT Magazine article goes on to point out that yoga, walking, and acupuncture may be more effective than injections. In looking through the alternatives, I was surprised to not see massage among the options given.

Massage therapy has been shown to be effective for short term relief of low back pain. I don’t think anyone would argue that having someone rub your back can be helpful. If anyone really doubts the point, the evidence review panel in Ottowa came down highly positive on the statistical results for massage and short term pain.

But the more important finding was that the benefits may last for a long period. The most recent study found small improvements in both pain and structural mobility almost a year after receiving either relaxation or therapeutic massage.

Given that injections aren’t effective and may make things worse, will the same doctors who have moved to injections now move toward massaging their patients? It would be a very positive direction for medicine, reversing almost a century of touching patients less.  I would expect the result to be decreased pain, decreased blood pressure, and increased patient well-being. But I fear that if massage does enter the conventional model it will be relegated to a nurse’s aide, because many doctors seem to think touching the patient is a burden and not a privilege.


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