Epidural steroid injection or Prolotherapy

Prolotherapy doctor Cherry Hill New JerseyScott R. Greenberg, MD

A patient will often ask us about the differences between Prolotherapy, Platelet Rich Plasma Therapy, Stem Cell Therapy, and Epidural steroid injection. Research suggests that the differences is in the patient outcome.

    • Epidural steroid injection did not significantly decrease the number of patients who underwent subsequent surgery compared with a placebo or other treatments.” 1

Further, the side-effects of a treatment that is not showing the desired results long-term: “Epidural steroid injection while one of the most widely used techniques to treat radicular pain, must be administered cautiously, with careful monitoring for systemic side effects.”2

Other research suggests adding hyaluronidase (to increase the absorption of the steroid) to the epidural injection was effective in the management of chronic low back pain in patients with failed back surgery syndrome demonstrated over a period of 4 weeks, ie temporarily. 3

Further, doctor’s looking at Worker’s Compensation cases found that “if you get Epidurals Lumbar injections after the first lumbar surgery was associated with high cost and longer claim duration.”4 Epidurals did not get people back to work faster.

Please see our article for more information about failed treatments for lumbar disc herniation.

Epidural steroid injection or Prolotherapy

In a recent study published in the Journal of the Canadian Medical Association noted what may be obvious to some: The sooner you treat back pain, the better the chance to alleviate pain and prevent later disability. Here is what they said: “Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain.” 5

This study did not gauge the types of treatment per se, but just that some type of treatment was preferable.

Unfortunately for many the first line of treatment for low back pain is some type of pain medication. Obviously medications can only mask the pain and not heal it. This often leads patients and doctors to be at odds over the effectiveness of their pain management.

Despite greater use of medications at greater chronic low back pain severity, current options remain less than optimal in providing analgesic efficacy

Researchers in the United Kingdom studying determining factors in treating mild, moderate, and severe chronic low back pain noted that “despite greater use of medications at greater chronic low back pain severity, current options remain less than optimal in providing analgesic efficacy.” 6

Worse, new research is suggesting that epidural injections of steroids for back problems may do more harm than good:7,8

In the medical journal Pain Practice, researchers noted that in their study of over 100,000 patients with chronic low back pain or osteoarthritis – “Opioids were the most frequently prescribed medication (more than 70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs more than 50%). Over 30% received antidepressants, more than 20% received benzodiazepines, and 15% in each group received sedative hypnotics.

Use of alternative treatments was as follows: chiropractor, Osteoarthritis 11%, chronic low back pain 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), Osteoarthritis 14%, chronic low back pain 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, less than 3% in both groups.

A case history from a patient:

“I had been experiencing pain in my lower back across my buttock and down my left leg. The pain was so bad at times I would lose my balance. I fell as though I have a high tolerance for pain and I am not a big believer in medicines especially painkillers. I asked my Doctor to send me for an MRI. I hoped the answer would be there and it wasn’t. I was told it was not bad enough to operate on and I was glad because that was my last choice and was told it would go away as fast as it came on. The pain that is. I had been going through this for eight months and that was a little much for any pain, especially this type which was my back, my buttocks, my leg and my mental being.

It was at this point I was recommended to see Dr. Greenberg, whom made me feel very comfortable at our first meeting. I felt confident with his confidence in what he was going to do to solve my problem. For the rest of the month the pain subsided and after three great treatments all pain was gone and some preventive measure was put in place. I feel great and thank you again Dr. Greenberg. I am now pain free.” RVH

Prolotherapy is a treatment where a cure for pain is sought, not a means to suppress symptoms. If you have tried the medical treatments including opioids, nonselective nonsteroidal anti-inflammatory drugs, antidepressants, benzodiazepines, sedative hypnotics, or chiropractor, physical therapy, transcutaneous electrical nerve stimulations (TENS), osteoarthritis acupuncture, hydrotherapy, and/or massage therapy, with less than hoped for results, then please consider and appoint for a Prolotherapy evaluation with us here in Cherry Hill, NJ.

1. Choi HJ, Hahn S, Kim CH, Jang BH, Park S, Lee SM, Park JY, Chung CK, Park BJ. Epidural steroid injection therapy for low back pain: a meta-analysis. Int J Technol Assess Health Care. 2013 Jul;29(3):244-53. doi: 10.1017/S0266462313000342. Epub 2013 Jun 17.

2. Bellini M, Barbieri M. Systemic effects of epidural steroid injections. Anaesthesiol Intensive Ther. 2013 Apr-Jun;45(2):93-8. doi: 10.5603/AIT.2013.0021.

3. C. Menezes Costa LA, Maher CG, Hancock MJ, et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ May 14, 2012 First published May 14, 2012, doi: 10.1503/cmaj.111271

4. Tao XG, Lavin RA, Yuspeh L, Bernacki EJ. Implications of Lumbar Epidural Steroid Injections After Lumbar Surgery. J Occup Environ Med. 2014 Jan 21. [Epub ahead of print]

5. Ghodraty MR, Nikzad-Jamnani AR, Nader ND. Adjuvant hyaluronidase to epidural steroid improves the quality of analgesia in failed back surgery syndrome: a prospective randomized clinical trial. Jan-Feb;17(1):E75-82.

6. Taylor-Stokes G, Lobosco S, Pike J, Sadosky AB, Ross E. Relationship between patient-reported chronic low back pain severity and medication resources.Clin Ther. 2011 Nov;33(11):1739-48. Epub 2011 Oct 15.

7. Radcliff K, et al. Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis: A Subgroup Analysis of the Spine Patient Outcomes Research Trial Spine. 15 February 2013 – Volume 38 – Issue 4 – p 279–29

8. Strong JA, Xie W, Bataille FJ, Zhang JM. Preclinical studies of low back pain. Mol Pain. 2013 Mar 28;9:17. doi: 10.1186/1744-8069-9-17.