Spine injections have long been used as a treatment for chronic back pain. Yet a new set of international guidelines, published by the British Medical Journal, strongly advises against their use. The question now is: should we continue spending money around the world on a treatment that, according to the latest evidence, doesn’t seem to work?
The Appeal of Spine Injections
Spine injections, particularly epidural steroid injections, are commonly used to treat chronic back pain, which is pain that lasts for more than three months. They are meant to reduce inflammation and provide pain relief, but their effectiveness for long-term pain has always been debated.
For many patients, the appeal is obvious: a quick, minimally invasive procedure that seems to promise relief without the need for surgery or long-term medication. Doctors, too, find them attractive, not only because they provide a tangible intervention for desperate patients, but also because procedural treatments tend to be well-reimbursed by healthcare systems and they are relatively cheap for the NHS.
The Evidence Doesn’t Add Up
Despite their widespread use, the effectiveness of spine injections for chronic back pain has remained unclear. Clinical guidelines have varied, with some recommending their use and others advising against them. The conclusion after assessing a wide range of common spinal conditions? Injections offer little to no real benefit for either central non-radiating back pain or radicular (nerve-related) back pain like sciatica.
A Costly Tradition
The persistence of spine injections as a standard treatment is not just a medical concern—it’s a financial one, too. In the United States alone, an estimated nine million epidural injections are administered annually, costing around $9 billion. While UK figures are lower, the NHS still spends a significant sum on these procedures. But if they aren’t effective, is this money well spent?
Why Do We Keep Using Them?
Understanding why spine injections remain so popular requires a look back at history. Pain medicine was largely developed by anaesthetists, who believed that techniques used for acute pain – such as injections and nerve blocks – could be applied to chronic pain. However, chronic pain behaves differently from acute pain, and what works for short-term relief often fails when applied over months or years.
Moreover, the medical system has financial incentives that favour procedures over non-invasive treatments like physiotherapy or lifestyle interventions. Patients too naturally gravitate toward options that appear quick and easy.
There’s also the psychological aspect: when a doctor acknowledges a patient’s pain and offers an intervention, even one with minimal effectiveness, it can provide a temporary placebo effect. Being treated in a hospital setting, with a white coat and sterile environment, can sometimes be reassuring in itself.
What Needs to Change?
The new guidelines raise an important question: should we stop offering spine injections for chronic back pain? Making such a change won’t be easy. Treatments that are deeply embedded in medical practice take time to phase out, and both patient expectations and financial structures make it difficult to shift away from procedural interventions.
One way to drive change is through funding decisions. If healthcare systems stop paying for ineffective treatments, demand will naturally decline. A better balance of reimbursement between procedural and non-procedural pain management, such as chiropractic treatment, physiotherapy, psychological support and lifestyle interventions, could encourage a shift toward treatments that offer real, lasting benefits.
The Future of Chronic Pain Management
Rather than relying on quick fixes, the focus should shift toward treatments that address the complexity of chronic pain. This includes better patient education, multidisciplinary pain management programmes, and support that helps people build long-term coping strategies. Chronic back pain is a serious issue that affects millions, but if we’re going to spend billions on treating it, we should make sure we’re investing in the most effective treatment.