Epidural Steroid Injections for Back Pain

(PEACE Trial)

This trial explores how different explanations of epidural steroid injections (ESI) affect back pain relief. It compares two groups receiving ESI: one hears a very positive explanation, while the other hears a neutral one. Another group takes medications such as gabapentin, nortriptyline, or duloxetine. This study targets individuals with back pain radiating down their legs, persisting for more than six weeks. Participants should have pain that aligns with MRI scan findings. As an unphased trial, it offers a unique opportunity to understand how communication impacts treatment outcomes.

The trial information does not specify if you need to stop your current medications. It's best to discuss this with the trial coordinators or your doctor.

Research has shown that epidural steroid injections (ESI) for back pain are generally safe, though some risks exist. Most people tolerate the treatment well. However, serious complications, such as a small risk of paralysis or death, have been reported. These severe outcomes are rare, particularly when the injection targets the lower back, which is the focus here.

In some studies, a few individuals experienced increased pain after the injection or mild allergic reactions. Despite these risks, many report reduced pain following an ESI. This procedure has provided pain relief since 1952, offering a nonsurgical option for those with back pain.

Researchers are excited about epidural steroid injections (ESI) for back pain because they offer a targeted approach to reducing inflammation and pain directly at the source. Unlike oral medications like gabapentin or duloxetine, which work systemically and can take time to show effects, ESIs deliver corticosteroids right into the epidural space around the spine, potentially offering quicker relief. This direct delivery might help patients experience less overall pain and improve mobility faster. Additionally, ESIs could provide an option for those who haven't had success with standard pain management treatments.

This trial will evaluate different methods of presenting information about epidural steroid injections (ESIs) for back pain. Studies have shown that ESIs can effectively relieve back pain, particularly in the short to medium term. Research indicates that patients with sciatica, characterized by pain traveling down the legs from the lower back due to lumbar disc issues, often experience significant relief after an ESI. In some cases, up to 79% of patients reported a substantial and lasting reduction in pain. However, the benefits may decrease after about five months and appear less effective for long-term chronic back pain lasting over a year. Overall, ESIs often provide more immediate relief compared to other conservative treatments.⁶⁷⁸⁹¹⁰