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Evidence summaries

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. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 18 studies with a total of 1 179 subjects. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. 10 out of 18 trials were rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and study quality (inadequate or unclear allocation concealment and inadequate intention-to-treat adherence).

References

  • Staal JB, de Bie R, de Vet HC et al. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev 2008;(3):CD001824. [PubMed]

Primary/Secondary Keywords