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Patient Evidence Summary
Doctor, I have lower back pain due to a herniated disc. Do injections of pain medications into the back have a lasting effect?
For some people with lumbar disc herniation, injections of lidocaine with or without steroids into their lower back can provide pain relief even after repeated injections over 1 to 2 years.
What is the evidence?
SUMMARY of FINDINGS
Lidocaine plus steroid vs lidocaine alone injections into the lower back
| Outcome | Lidocaine plus steroids | Lidocaine alone | Effect |
|---|---|---|---|
| 50% or greater pain relief at 1 year | 70 out of 100 people | 65 out of 100 people | no difference* |
| 50% or greater pain relief at 2 years | 62 out of 100 people | 60 out of 100 people | no difference* |
*although the rates for the 2 groups look different, the differences were not statistically significant —this means that the difference could simply be due to chance rather than due to the different treatments
What kind of study was this?
This was a systematic review of 7 randomized controlled studies published up to July 2016.
Who? The studies included 832 people with lumbar disc herniation (protective layer around the outside of the disc is torn so the inside can push through to press on nerves) (5 studies) or lumbar spinal stenosis (narrowing of space around spine which can put pressure on nerves) (2 studies) who were followed for at least 1 year (average age 42 to 57 years old). People who had spinal surgery in the past were excluded.
What? The studies compared lidocaine plus steroid injections with lidocaine injections.
Lidocaine plus steroids | vs | Lidocaine alone |
|---|---|---|
Lidocaine plus steroid injections into the lower back If people had pain relief after the first injection, additional injections were given when the pain returned (average number of injections 5 over 2 years) People were allowed to take other pain medications as needed and to participate in physiotherapy or exercise programs | Lidocaine injections into the lower back If people had pain relief after the first injection, additional injections were given when the pain returned (average number of injections 5 over 2 years) People were allowed to take other pain medications as needed and to participate in physiotherapy or exercise programs |
Why was this research done?
Lumbar disc herniation is a frequent cause of lower back pain. Injections of medications into the back around the spinal cord relieves the pain for some people. The reveiwers wanted to know if injecting lidocaine (an anesthetic drug used to block pain during surgical procedures) alone was as good as lidocaine plus steroid (drugs that reduce inflammation) injections in reducing pain after 1 to 2 years of treatment. They found that both options reduced pain in 70 out of 100 people at 1 year and in 60 out of 100 people at 2 years.
This Evidence Summary is based on the following article:
Zhao W, Wang Y, Wu J, et al. Long-Term Outcomes of Epidurals with Lidocaine With or Without Steroids for Lumbar Disc Herniation and Spinal Stenosis: A Meta-Analysis. Pain Physician. 2020 Jul;23(4):365-374. PubMed
Published: Monday, December 7, 2020
Last Updated: Tuesday, July 13, 2021
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
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, McMaster University