Why Nerve Root Injections Are The 51st Shade Of Gray

Friday, August 12th, 2016

This week, we compare shots in the neck or cervical region to spinal manipulative therapy, which is also known commonly as chiropractic adjustment.

I have highlighted the lack of evidence for the use of the epidural spinal injections before and the the lack of effectiveness beyond that of just short term reduction of inflammation. Epidural spinal injections have shown no benefit at all beyond some short-term pain and inflammation reduction and zero usefulness in regards to long-term disability or the eventual need for surgery. Zero.

A paper by Nancy Epstein in 2013 and published in Surgical Neurology International stated, “Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications.

In addition to that information, there is research showing that each subsequent epidural spinal injection puts the patient at a 26% greater risk of spinal fracture down the road. My question is, “Why on Earth are people getting these injections at such an alarming rate when the research is taken into account?”

Hey, I’m not making this stuff up!

My only guess is that the research isn’t getting taken into account. One would think that these injections would be on the decline. However, despite the research showing the ineffectiveness of them, the popularity of the injections have only increased. Don’t take my word for it. Consumer Reports said, “Controversy surrounds these injections, and use has increased dramatically in recent years, along with escalating costs.” They went on to add, “Some experts believe that their growth reflects—in part—the rising prevalence of lower-back pain. But others suspect it’s driven by financial incentives. Our analysis of the evidence, based on a recent report by the American Society of Health-System Pharmacists and several published reviews and treatment guidelines, suggests that while the shots might have limited value by providing short-term relief to some people, in most cases people should try other measures first.

Again, you don’t have to take my word for it here.

With all of that in mind, let’s look at this week’s research comparing the injections to chiropractic adjustments for neck pain.

Why They Did It

The authors wanted to attempt to measure the overall outcome in regards to pain, improvement, and costs of cervical (neck) root injection blocks vs. chiropractic spinal manipulative therapy.

How They Did It

  • The study included 104 participants.
  • Each had a disc herniation that was confirmed by MRI.
  • 52 underwent treatment via the nerve root block.
  • 52 underwent chiropractic spinal manipulative therapy.
  • Baseline pain scores were collected on each individual using the numerical rating scale (NRS).
  • The NRS was also taken three months after the end of treatment for improvement comparison.
  • Improvement was measured with the Patient Global Impression of Change scale.

What They Found

  • 86.5% of participants in the chiropractic spinal manipulative therapy group showed significant improvement.
  • Only 49% of the nerve root block group reported improvement.

Wrap It Up

Subacute/chronic patients treated with SMT were significantly more likely to report relevant “improvement” compared with CNRI patients. There was no difference in outcomes when comparing acute patients only.”

So, the next time anyone tells you to get nerve blocks or and epidural injection for pain as a result of a herniated disc, consider this blog and consider getting a second opinion from a doctor of chiropractic before undergoing a mostly useless and potentially dangerous treatment protocol.

Peterson, CK, “Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy.” J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):210-7.

Nancy Epstein, “The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature” Surg Neurol Int. 2013; 4(Suppl 2): S74–S93.