Steroid Shots No Better for Back Pain Than Placebo
By NICHOLAS BAKALAR
AUGUST 24, 2015
Steroid shots are commonly used for back pain, but evidence that they work no better than placebos is mounting.
In a review published Monday in Annals of Internal Medicine, researchers combined data from 30 placebo-controlled studies of epidural steroid injections for radiculopathy (back pain that radiates to the legs) and eight studies of spinal stenosis (back or neck pain caused by narrowing of the spinal canal).
The study showed that for radiculopathy, injections provided some short-term pain relief, but over time were no more likely to be helpful than placebos, and they did not reduce the need for later surgery.
The pooled data showed similar results with injections for spinal stenosis — some moderate temporary pain relief, but no differences between treatment and placebo in pain intensity or functional ability lasting six weeks or longer after the shot.
The authors acknowledge that most of the trials had methodological shortcomings, and that some analyses were based on small numbers of patients.
Dr. Roger Chou, the lead author and a professor of medicine at Oregon Health & Science University, said there was probably some financial motivation for continuing to use the procedure despite the lack of evidence for its effectiveness. “The professional societies are concerned because they worry about the implications for insurance coverage,” he said. “We don’t say anything about that in the study.”
Living With Cancer: Collateral Damage
By SUSAN GUBAR
AUGUST 27, 2015
When I was invited to attend a prostate cancer group called “Us Too” in my town, its members were meeting in a private room in our public library. About eight men, some accompanied by their wives, had great difficulty communicating their discomfort about urine leaks and diapers. They wanted to know what strategies my gynecological cancer group used to talk about sexual issues. To alleviate their daily problems, the participants needed professional help that I could not furnish.
Sexual dysfunction and incontinence in prostate cancer survivors underscore a quandary that shadows oncology. As we all realize, procedures that prolong lives also impair them. Yet cancer patients who must forfeit quality of life to gain quantity of life rarely receive adequate warning before treatment or guidance afterward.
A vigorous defender of conventional medicine, the British journalist John Diamond nevertheless admitted that the impairments he faced had nothing to do with his throat cancer but were instead produced by efforts to cure him of it: a missing lump of tongue, a hole in his throat from a tracheotomy, shooting pains in the neck and jaw, the loss of voice and saliva glands and tastebuds, a limp, edema, overproduction of mucus and saliva, ulcers, a frozen shoulder, toothache, constipation, diarrhea, and radical weight loss. The surgery, radiation, and chemotherapy that inflicted these damages gave him four years of a compromised existence.
The initial operation for ovarian cancer certainly disabled me. A debulking operation led to a perforated intestine and infections that in turn led to an ileostomy: a bit of intestine brought out of the body and attached to the belly for the purpose of excretion. Another woman in my support group had to have an ileostomy when an experimental drug caused a fistula, an abnormal duct or passage.