A single intradiscal glucocorticoid injection reduces low back pain associated with active discopathy at 1 month for patients in which first-line conservative treatments had failed. However, the effect decreased over time. The results of a randomized trial are published in Annals of Internal Medicine.
Researchers conducted a prospective, parallel-group, double-blind, randomized, controlled study at 3 tertiary care centers in France with expertise in managing spinal disorders to assess the efficacy of a single glucocorticoid intradiscal injection in patients with chronic low back pain with active discopathy. Participants with chronic low back pain with active discopathy were randomly assigned to a single intradiscal glucocorticoid injection during discography (n = 67) or discography alone (n = 68). The patients were asked to rate their lower back pain severity 48 hours before the intervention and at 1, 3, 6, and 12 months. Patients who received a single intradiscal glucocorticoid injection reported positive effects on pain at 1 month compared with the control group. The effect decreased over time with no differences in low back pain intensity between groups at 12 months.
Active discopathy is associated with a specific phenotype of chronic low back pain. Local inflammation has a role in active discopathy-associated symptoms. As such it makes sense to evaluate treatments that target local inflammation, such as glucocorticoid intradiscal injections. However, given these findings, the researchers question the efficacy of glucocorticoid injections as a treatment for chronic low back pain.
Article: Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy: A Randomized Trial, Christelle Nguyen, MD, PhD; Isabelle Boutron, MD, PhD; Gabriel Baron, PhD; Katherine Sanchez, MD; Clémence Palazzo, MD, PhD; Raphaël Benchimol, MD; Guillaume Paris, MD; Étienne James-Belin, MD; Marie-Martine Lefèvre-Colau, MD, PhD; Johann Beaudreuil, MD, PhD; Jean-Denis Laredo, MD, PhD; Anne Béra-Louville, MD; Anne Cotten, MD, PhD; Jean-Luc Drapé, MD, PhD; Antoine Feydy, MD, PhD; Philippe Ravaud, MD, PhD; François Rannou, MD, PhD; Serge Poiraudeau, MD, PhD, Annals of Internal Medicine, doi: 10.7326/M16-1700, published 21 March 2017.