Steroid Injections for Back Pain - No More Effective Than Placebo.

NY TIMES: Steroid Injections for Back Pain - No More Effective Than Placebo. 

A randomized trial of steroid injections for back pain has shown that they are no more effective than a placebo.

Because the long-term benefits of surgery remain unproven and pain medicines often have serious side effects, doctors have increasingly turned to steroid injections to treat lumbosacral radiculopathy, a common cause of back pain. The condition stems from damage to the discs between the vertebrae that often leads to sciatica, numbness or pain in the legs.

Researchers tested 84 adults with back pain of less than six months’ duration, dividing them into three groups. They received either steroids, etanercept (an arthritis medicine) or an inactive saline solution in two injections given two weeks apart.

At the end of one month, they were assessed for pain.

Leg and back pain decreased in all three groups, but there were no statistically significant differences among them. The researchers conclude that steroids may provide some short-term analgesic effect, but that the improvement in all of the patients was mainly due to normal healing.

The lead author, Dr. Steven P. Cohen, an associate professor of anesthesiology at Johns Hopkins, was disappointed with the results but said that he still hopes drugs like etanercept might someday be proven effective. But for now, he said, “the strongest evidence for back pain relief is with exercise.”

The study appears in the April 17 issue of Annals of Internal Medicine.

http://well.blogs.nytimes.com/2012/04/27/for-back-pain-steroid-shots-no-more-effective-than-placebo/

Antibiotics and placebo equally effective for sinusitis treatment ?

In another story highlighting the unnecisary prescription of antibiotics; a recent study specifically on sinusitis has found that placebo (a pill containing nothing in it) is just as effective as the antibiotic prescribed. 

 Antibiotics are commonly used to treat sinusitis, but a new clinical trial has found that a placebo works just as well.

Scientists randomized 166 adults, all of whom met the diagnostic criteria for sinusitis, to receive the antibiotic amoxicillin or a placebo three times a day for 10 days. On the third, seventh and tenth days, the participants recorded their symptoms.

There was no significant difference between the two groups in the amounts of time missed from work or everyday activities, relapse or recurrence rates, adverse effects or satisfaction with the treatment. Nor was there any difference in self-reported improvement in symptoms, except on the seventh day, when 74 percent of those taking amoxicillin reported improvement, compared with 56 percent of those on the placebo.

The authors acknowledge that it is possible that not all patients in the study had bacterial sinusitis, since the diagnosis is made clinically, not by a laboratory test. (Antibiotics, of course, are ineffective against a viral infection.)

“I hope that the results here will give doctors evidence to use in discussions with patients about avoiding unnecessary antibiotic treatment,” said the lead author, Dr. Jane M. Garbutt of Washington University in St. Louis.

The study appeared last week in The Journal of the American Medical Association.

Original published story ran here: 

http://www.nytimes.com/2012/02/21/health/research/in-sinusitis-antibiotics-are-as-effective-as-placebos-study-finds.html?_r=1&ref=science