Back pain is a huge cause of suffering to humanity and often a very difficult problem to treat – or even properly diagnose – unless one can consider ‘a bad back’ a diagnosis. So it came as a bit of a surprise to see the front page of the Daily Express today which has the huge headline:
SIMPLE JAB TO CURE BACK PAIN
Now for me ‘cure’ is a very big word indeed so I eagerly bought the Daily Express – but my search for a ‘cure’ to the debilitating problem that apparently costs us £12 billion a year in sick leave was to end in disappointment.
The article refers to the work of Steven Cohen, an anaesthetist at Johns Hopkins Medical School (a fine institution) in which he shows that back pain relieved by epidural steroid injections (and that is by no means all back pain) the relief may be due to the injection and not the steroid. This is because injections of salt water appear to do just as well as steroid injections – not that steroid injections (or salt water ones) can ever be claimed as a ‘cure’ for back pain. Amazingly this is being presented as a medical breakthrough all over the net but at least one major TV news company led with a rather different headline on the same story.
Spinal Injections may not aid lower back pain
Notice the word ‘not’. That seems to be a more honest and intelligent appraisal of Prof. Cohen’s work than what appears in most of the media. But even this is misleading as the injections (with or without steroid) do seem to have some effect.
What Cohen might have shown is that the steroid in the epidural injections may have nothing to do any possible good effects of these injections because the placebo treatment (saline) has just as good effect.
However I can hear anybody trained in musculoskeletal triggerpoint acupuncture (as I am) screaming at their newspapers and computers: ‘It’s the acupuncture effect! Dammit!’ For 5000 years acupuncturists have known that the thin, safe and cheap needling that occurs in acupuncture can relieve many sorts of musculoskeletal pain. Indeed many books have been written on the subject.
This may not be the news that the makers of steroid injections were waiting to hear but it is certainly no miracle ‘simple jab’ breakthrough in back pain either. In my next post we will look at significant challenge to the medical profession posed by back pain and explore what can be done to help.