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Subscribe to RSSThe quest for relief from pain has now resulted in the deaths of 19 people and a total of 247 confirmed infections of fungal meningitis from tainted steroid injections. Thousands more who got the injections, made by the New England Compounding Center in Massachusetts, are worried that they too may wind up sick or dead.
The horrific outbreak has resulted in the outrage about a lack of oversight of the compounding pharmacy.
But, this tragedy has another aspect that is not getting sufficient attention. Why are so many Americans getting spinal injections?
Most people in the United States will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work. It has also spawned a lucrative industry of spinal injection treatments whose efficacy, safety and long-term utility are mixed.
Epidural steroid injections are a common treatment for many forms of low back pain such as bulging discs, sciatica and leg pain. Experts agree that injections should be a last resort after patients in pain have tried anti-inflammatory medications and physical therapy. Millions of Americans get shots but far too many as a first attempt at relief, rather than a last resort.
The use of spinal injections, which have been around for 50 years, has been growing rapidly with one study reporting a 629 percent increase in Medicare expenditures for epidural steroid injections over the last decade.
Back pain injections can cost as much as $600 per shot. Insurance will pay much of the cost and there are often a lot of shots given. Sadly, there are lots of programs all over America that advise you on the Internet and in newspaper ads to come in and get a shot for back pain before trying anything else – that’s just lousy medicine.
Do the shots work? Many patients who get them say they do. But the evidence is not convincing that people do better with shots than pain relievers and anti-inflammatory drugs. One recent, blinded study, published in the British Medical Journal, showed that patients reported as much pain relief with saline placebo shots as those who got epidural steroid injections.
Another study, published in 2007 in the medical journal Spine, showed that shots are most useful for people with herniated disks and pain radiating into their legs or arms but fewer than half of the injections given are for these conditions.
The explosion in back pain injection treatment closely parallels the explosion of obesity in the United States. Not surprisingly, the treatments that have the best evidence of helping relieve back pain are losing weight, exercising more and maintaining better posture. We are becoming a society that relies on symptom relief for health issues, not fixing the underlying problem.
No one should have to fear getting a fungus that might kill them when they go to get treatment for their back pain. Our legislators and regulators have let us down when it comes to keeping an eye on mom and pop drug makers. But, too many of us are using spinal injections as the first response to back pain. And too many doctors and clinics are pushing that treatment as an easy fix. Nothing is easy when it comes to pain. Medicine needs to stop promoting quick and very lucrative fixes for back pain when for a lot of people who suffer an alteration in lifestyle should be what the doctor orders.
Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.
Related stories:
Deadly fungal meningitis outbreak tied to shots isn't the first
First case history shows fungal meningitis can destroy brain fast
Four more die in fungal meningitis outbreak
NYT: Quality lapses in drug factories add to dangers
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"The explosion in back pain injection treatment closely parallels the explosion of obesity in the United States. Not surprisingly, the treatments that have the best evidence of helping relieve back pain are losing weight, exercising more and maintaining better posture. We are becoming a society that relies on symptom relief for health issues, not fixing the underlying problem."
Can we get an "Amen!" to that?
That's easy to say but if you can't exercise to lose the weight due to extreme pain, you have to address the pain first to make exercise bearable. Otherwise it ain't gonna happen. The pain leads to less activity and weight gain.
I've had the shots and it makes moving easier and allows me to get out and have daily exercise. Losing weight will follow naturally.
Don't judge until you've walked a mile in the other person's shoes. If you could walk that far with the debilitating pain.
Amen to THAT! I have a herniated disc with pain that radiates down my leg. It is all I can do some days to get up and shower and go to work, much less exercise. Before the pain got so bad, I did do physical therapy, which did not help at all. I also tried anti-inflammatory medications, which did not help at all. My doctor suggested the shots as a less-invasive alternative to surgery. I had six shots, two at a time each week for three weeks. It did provide some relief from the pain, and when you're in constant pain, SOME relief is worth almost anything. So judging others' decisions when you have no idea what they're living with is just rude. (And full disclosure, yes, I am overweight, but only slightly.)
Amen to the quick shot that may eliminate the pain but not the underlying or cause of the problem. Now another problem arises most likely due to human cause. Any treatment is the knife with 2 sharp ends. And from Dolphinfree said, pain and obesity are the vicious cycle. If you treat the pain, you may be able to work out to loose some weight. But have we seen more people loose weight after the pain was treated, I have not. I have seen people trying to loose weight after a serious health issue and success.I have been wondering how people in developing country dealing with "chronic pain". I am very sure that a lot of them don't have the money to pay for this fancy "epidural" injection.
We don't have a society working at meanial physical labor anymore. We do seem to have more "pain". We do seem to have a large number of disabled people unable to work but doing quite well at recreational activities. Plenty of people with horrible diets, couch potatos who are prediabetic at 30 and full on diabetics by 40~45. Oxy pain meds cannot be made fast enough to fullfill all the Rx's for them. People volunteer for lapband surgery, epidurals, and other surgeries. Like a keep up with the jone's competition. The docs of course have become "pushers" for all this. Diabetes is no threat to them because everyone they know has it, takes the meds and seems to be fine. Pay your premium of a couple hundred and your $15 co-pay and use $1,500 per month in med care from now through the next 30 years and swear you are paying your own way. We have many disconnects from reality in our society. The more TV everyone watches the worse it gets.
<AMEN!>
I don't know exactly which comments I'm "Amening" to but it just feels good. Nice stress relief. Go ahead - try it. You only live once. No matter who's around you, yell AAAAYY-MEN! See? Back pain gone. If you're at work, so is your job. But hey, what do I look like here? The Dalai Lama?
</AMEN!>
A lot of unnecessary low back pain treatment happens because patients are not patient. They expect an instant cure, pill or injection. Unfortunately, the medical system in the US has become a big business and is more interested in making money than telling patients what they really need to know. Back pain is common. The treatment for acute back pain is as follows:
First, your back needs a period of rest. A short period of bed rest is in order.
Second, get some pain relief with an over-the-counter medication.
Third, place some ice on the areas that hurt.
Fourth, after the bed rest and pain medicine have begun to give you some pain relief, and as soon as you notice any improvement, get moving.
Fifth, address muscle spasm with rest, massage, and/or heat.
Sixth, give your body a chance to heal. Takes 2-12 weeks.
Seventh, gradually resume normal activities.
Eighth, gradually strengthen your back. Some exercises will make it better; some will make it worse. Find out which are which. Don't start them, yet. You have a couple weeks to figure out the difference.
Ninth, eventually increase flexibility once the pain has resolved. Don’t overdo it.
IF there is no improvement after two months, or there are progressive neurological deficits or intractable pain, then other treatments MAY be warranted. Steroid injections are statistically no better than
1. Any form of traction, including VAX-D, DRS, DRX, Inversion Therapy, Lordex, etc.
2. Trigger point injections.
3. Facet injections.
4. Sacro-iliac injections.
5. Acupuncture
6. Paleo (or any other fad) diet
7. Magnetic Therapy (of any type)
8. Prolotherapy
9. Reflexology
10. Over the counter nutritional supplements
11. Qigong
12. Cupping
Surgery is not indicated in 90-95% of cases. The surgeon needs to make a real case that he understands the cause of the pain and that the pain will go away with the surgery. There is a lot more info on my blog if you are interested.
Bill Yancey, MD
Whatyourdoctor dot b l o g s p o t dot c o m
Many studies have shown that the best approach to low back pain is chiropractic care. I know, many will attack me and say chiropractic is useless or worse but the studies show otherwise. For those with an open mind, give it a try. For those who would never go to a chiropractor no matter what, enjoy your pain and shots along with all the side effects.
It totally depends on what the problem is. If there is a herniation, even a (respectable) chiropractor will tell you they can't fix that. There are probably some things a chiropractor is good for, but not all back problems can be solved so easily.
@Johnr123 and Wolfgirl. John, I totally 100% agree w/the Chiropractic approach. It is the best way. Unfortunately though, that field of medicine is rife w/"quacks" who don't know what they're doing. It can be hard to find a good chiropractor. Wolfgirl, I have had a herniated disk w/extreme pain down my left leg. I was not able to walk w/o a walker. It was very difficult to sleep. I went to my chiropractor and over the space of about 3 months or so w/spinal decompression treatments and messaging and pushing on the disk (yes, that smarted), he got the disk pushed back into its proper place. At first he was afraid that I would need surgery and I said "no!" They key to this though is getting the herniated disk treated by a good chiropractor immediately before it has time to set.
Chiro's have signs outfront that advertise "Chiropractic Massage". My boss who was a big fan of therapeutic massages would pay $100 for a massage until he found he could pay a $15 co-pay to the Chiro and get his massage. The Chiro had to make up a lie to file the claim for the Med plan to pay him. We all knew the boss did not have a bad back or health issue requiring medical treatment. Lots of people do this kind of abuse of premium dollars. Then they get the 30% rate increase and have to pay it or their employer cuts the plan or kills it. This is what I call canibalization. Americans do this to each other all day everyday. Used to call it lying and cheating, now people call it being smart. Don't know how smart it is to fool around till you kill your medical plan.
Sorry folks but these shots are a JOKE. My husband has had 2 back surgeries in 20 years and has done everything that the doctors shove at him - chiropractor, therapy, pool therapy and about 10 rounds of these shots until the last one at Christmas 2007 at the Beth Israel pain clinic in Boston they said they had a new "heat" steroid shot they wanted to try and refused to renew his pain medication if he did not try it. The needle was as long as my forearm and they messed him up so bad that he could not walk properly for 6 weeks afterward. Then the JERKS turned around and said it was all in his head -- really? then why - to this day - does he still have a HOLE in his back where they gave him the shot?? He swears it made him worse and now refuses to even discuss these horrid shots. This all happens because doctors are too petrified to simply write a pain killer prescription on a long term basis -- sorry folks, but some people need pain medication and then the doctors play games with their lives and refuse to give it to them which forces the patient to go for these quack treatments so the doctor can tell the insurance company and the DEA that they tried everything. I wonder how many of these poor people who died were forced into getting these shots because their doctors threatened to withhold the pain medication that the desperately need to LIVE a normal life ??? My bet is that it is more than a handful and the families should look at exactly HOW the patients were set up for the shots and WHY because there are going to be cases where the referring doctor did exactly what my husbands doctors have done to him all of these years -- withhold pain medication and force people to go for these whack-job treatments. And my husband is not obese and he is a carpenter who moves more than most every day - and without a pain killer he would not be able to get out of bed and go to work everyday.
sadly Mary, the doctors really don't have that much choice. they are trying to comply with ridiculous amounts of new government regulations in order to keep their licenses. the idiotic 'War on Drugs' that the government is still wasting billions of dollars on every year (and are still losing) is increasingly making criminals out of the true patients who are most in need of pain relief and the people who can help us. and the reason that no candidate ever talks about ending the war on drugs? because too many people are making too much money to ever allow it to go away. and once again, we the people suffer
Dr. Kaplan may have a valid point. However, the tone of this article seems to paint with a very wide paint brush. A competent MD should not be doing caudal injections unless an MRI demonsrates that there is disc herniation, arthritic changes, or some objective evidence that there exists a valid reason for the injections. Obesity is not a reason for these injections by itself. I had back surgery in 2009 because I had developed "foot drop" which is an indication of nerve impingement. The surgery helped, but I was forced to retire from a job that I loved and that paid well( after 30 years of service) because the nerve pain in my right leg was so severe that I could barely walk. Even after retirement, the pain was relentless and I was unable to stand, walk, or perform even normal tasks such as grocery shopping, playing with my grandchildren or doing anything other than sitting in a chair. Even then the pain was extremely bad. I have always taken a taken a very conservative approach to surgery or medical intervention. I have a very high pain tolerance as I have been in severe pain for 18 years before I retired. Pain meds can only do so much and all people will eventually develop a tolerance to the pain meds. There is a limit to the amount of pain meds that a person can take without either becoming addicted to the meds by exceeding the prescribed dosage or by accidental overdose. I have always followed the prescription, knowing that I will never be pain free. Several months ago, I had another MRI as well as an EMG ( Nerve conduction test) done. The EMG showed that the L5 nerve in my right leg is totally unresponsive to electrical conduction. In other words, that nerve is essentially dead. Paradoxically, this causes extreme pain. The MRI showed disc herniation, major multiple arthritic changes, as two vertebrae that are out of line (subduction). I was referred to an orthopedic surgeon, who like me, believes that surgery should always be the last resort. I was referred to a pain management specialist, who gave me a caudal injection, which enabled me to actually function as a human being for about three weeks. I had a 2nd injection last week. I hope that after a total of 3-4 injections, I may get relief for a few months at best. Dr. Kaplan states that the injections should be the last resort. I doubt that he is an M.D. as surgery should be the last resort. Yes, there is a risk with these injections, even without the fungal issue. However, the author minimizes the pain that some of us can feel. Unless you have experienced pain that is totally debilitating, it is heard to appreciate how throughly it destroys all quality of life, especially long term pain that has lasted two decades. I cannot even remember the precious gift of waking up and feeling good. This is not meant to elicit sympathy, it is just a statement of fact. Yes, I need to lose 20 pounds, but this will not cure the spinal problems, as Dr. Kaplan suggests. As medical science has already discovered, genetics plays a very important role in your health. Twenty five years ago, I could jog 3-5 miles a day and bench press more than my total body weight. Since both of my parents had severe arthritis, I also have developed severe arthitis. Surgery cannot cure arthritic impingement on spinal nerves and surgery should always be the last resort as no surgeon can guarantee results. I have already been through physical therapy prior to surgery in 2009. It did not help. Dr. Kaplan- whenever you paint, please always use the brush that is proper for the job or else as a bioethicist, you end up violating the basic tenets of your profession. I'm sure that you did not intend to offend;however I just wished to clarify a couple of points. Severe pain has taught me many things: humbleness, kindness, and the precious nature of life. None of us can imagine where life will take us, but it does cause the lens of life to focus on what is really important. Trials and tribulations can break us, help us to grow, or cause us to lose hope. The Bible teaches us that "when I am weak, then I am strong." Constant pain has caused me to REALLY turn to God. I know that Jesus Christ is my Savior and that one day ( I feel very soon) I will have a new physical body that is immortal, eternal, and that doesn't ever get sick or hurt. I am eagerly anticipating that day.
Yes they do give to many of these shots. I have a genetic condition that has messed up my spine. The only thing that helps is, what they call radio frequency treatments. However to get that treatment I must first go through the steroid injections that do nothing to relive the pain. They are required by my insurance.
Sorry, but I've had the injections and they offer immediate relief. The pain pills, the NSAIDS all have side effects. The procedure was painless and the results were great. Unless you've had serious back pain you don't know what you are talking about.
A radical idea: What if doctors got paid LESS for giving a shot than for spending 20 minutes talking with the patient, and sending them to physical therapy? Any procedure that a doctor can charge over $600 for is going to get used a lot, whether it helps the patients or not. It's just like ordering MRIs when the doctor owns the MRI machine and the insurance companies (or Medicare) will pay $1500 a pop for using it -- you don't want to have it sitting there unused and not making you any money. Change the financial incentives, and I guarantee the medical practice will change overnight.
As someone who works for a Medicare Advantage plan, I can tell you that Medicare WON'T pay for a MRI done when a doctor owns the equipment without full disclosure to the patient, up to the patient signing a form acknowledging the fact the provider has made them aware. And most health plans require pre-authorization for MRI's, precisely because they do cost so much.
1. Yes, doctors do get paid way too much for these shots. This is why these disgusting ads have shown up touting these injections. These people make more than $300,000+ a year doing this, about twice what most real primary care doctors do. And most of these people don't do anything but these injections: they don't talk to the patients, they don't fill out the disability forms, they don't prescribe them medications, etc. Just bang, give a shot and out the door. (Some doctors don't, but I'm talking about the types that have these ads for shots).
2. However, these shots, if done correctly, REALLY HELP most people. I would estimate 60-80% of all people get help that lasts months. The problem with these various tests comparing efficacy of injections, is that some doctors are just plain crummy at this. Plus there are different types of epidural injections. The old type I would say had a 50% efficacy at the most. The newer transforaminal injections are up to 80% successful.
3. The article notes that 50% of the people getting the shots did not have pain down their leg. Well, there is something called a facet injection and that is VERY helpful for back pain caused by back arthritis and is pain that doesn't go down the leg. So, if these people were included in the study, there is a good reason to also do these injections, but I saw no mention that there are various types of injections, so I don't know for sure.
This is a well thought out response. Thank you for it. Clearly Dr. Caplan hadn't disclosed that information about including ALL injection types; facets too, which skewed the results of the study. The study also was flawed because it reported results out at 6, 12, and 18 months. Facet injections are measured in hours or weeks as they are diagnostic and not necessarily therapeutic because they are precursor procedures to radiofrequency lesioning.
Epidural injections don't repair herniated discs. They shrink tissue that swells because of the herniation. When a disc herniates, material leaks. Substance P, cytokines, this is all like battery acid to the tissue around the disc and nerve. Epidural injections kind of "flush" this material away and deposit the steroid into that area, shrinking that inflamed tissue back away from the nerve and disc. In time, the body will eat away a little at the disc, kind of wall it off, scar it over, but the only thing that will make it go away is a surgeons knife. You have to learn behavior modification and structurally change your body to protect the weak area to prevent another painful "blowout" in the future once we make that pain better. THAT'S why you have to go to physical therapy. THAT'S why you have to learn how to move, bend, twist, lift again. THAT'S why you have to lose weight. THAT'S why we sent you there.
Opioids are not usually prescribed for these conditions except as a last resort, when the patient has failed every available interventional option, and then used only at the lowest possible dose and as an extended release medication. No place for Percocets, Vicodins, Oxycodone.
The relief from injected spinal corticosteroids is not 80 to 90%. 30 to 50% will attain some relief and a very few will attain 80-90% long or short term relief. Very few achieve 100% relief for a short or long term period. Of course, I can see from research one will find varying reports depending on what and if the injections were done properly and for the correct conditions they are supposed to help patients find and attain relief. Many patients find they are worse off with their debilitating pain after the injections. But when Drs. hit the jackpot with a 'cure all' those who cannot function doing the smallest normal task because of pain, patients will try almost anything, to find relief. If they can afford it..
What can I expect after the injection?
The initial response to the injection may be heaviness and tingling of the legs. You may also experience significant pain relief. This is due to the local anesthetic mixed with the corticosteroid. Pain may return within a few hours, after the local anesthesia wears off but before the steroid has had a chance to work. In addition, there can be some discomfort in the area of the injection due to irritation from the needle itself as well as an initial response to the corticosteroid. This should only last for 24-48 hours. Ice packs may help reduce the inflammation and will typically be more helpful than heat during this time. Improvements in pain will generally occur within 3-5 days after the epidural injection but may be noticed sooner.
Epidural steroid injections help to relieve pain in approximately 50% of patients. These effects tend to be temporary; we have seen positive results lasting from just a few days to many months. The overall effectiveness of an epidural steroid injection is often related to the cause of the back pain. Patients with disk-related pain tend to do well while patients with structural spine problems (such as spinal stenosis) tend to have poorer response rates. In addition, length of time that the patient has been experiencing symptoms tends to influence outcome as well. The injections are slightly less effective in patients who have been experiencing pain for a longer period of time. The few studies that have looked at long-term pain relief after an epidural steroid injection have shown that 50% of patients who initially responded to the injection will have recurrent pain after 12 months.
Importantly, an epidural steroid injection can provide the pain relief that is needed to allow a patient to progress with their rehabilitation program. Long-term improvement can often be obtained when epidural steroid injections are followed by appropriate forms of physical therapy. Individuals who have less back pain and feel more comfortable are generally able to work on the therapy that is critical to rehabilitate the lower back and prevent or minimize future episodes of lower back pain (including stretching, strengthening/pain relief exercises and low impact aerobic conditioning).
How come I am being scheduled for a series of injections?
In some patients, the pain relief after an epidural steroid injection will be permanent. In others, the pain will be lessened enough to allow the patient to progress with rehabilitation and exercise, which helps the patient heal and find pain relief on a long-term basis. If excellent pain relief is obtained from the first epidural injection, there will be no need to repeat it. If there is a partial benefit (greater than 30% relief from pain) the epidural injection can be repeated for possible additional benefit, or it may be necessary to conduct additional tests to more accurately determine what is causing the patient’s pain. It has been shown that results tend to improve and become more long lasting with “overlapping” doses of steroids. Up to three epidural steroid injections may be performed within a one-year period, as long as they are spaced at least 2-4 weeks apart. Injections performed more frequently can increase the risk of corticosteroid side effects. If the initial injection provides minimal benefit (less than 30% pain relief) the physician may either repeat the injection, or try a different type of injection or treatment.
I had a RA doctor who insisted that steroid injections would help my spine and back pain as I have degenerative disc disease. I took shots for a year without benefit. I also had knee injections that was suppose to help my knees. No help at all.
I got another doctor who advised me not to have any more shots. Interestingly, I had less pain over time without the injections....
The chiropractor has saved me and my family from back pain of the worst type.
It's non-invasive, much less expensive, and it lasts! Kick the drug habit and go natural!
not all types of back pain will respond to chiropractic. and herniated disc issues can actually be worsened by certain types of twisting adjustments. the reason there are so many kinds of treatments is because 'back pain' is a catch-all term for many different types of problems. recommending a single solution to all of them is extremely ignorant
Chiropractic only works though, if you catch the injury immediately.
Allie22, I agree, but it has to be done immediately. I had a herniated disk and my chiropractor got it pushed back into place. No twisting or "crunching," but by spinal decompression and massage which included pushing his fingers into the disk to help push it back in.
Chiropractors are the best for this type of problem...they have helped me and my family.
It is effective, it is non-invasive, it is way less expensive, and it lasts. Go natural!
About one year ago I began having pain in my arms. It got so bad that I was losing the use of my left arm. After I had x-rays and then mri's I was told it was a problem in my cervical spine. I had the shots and it was instant relief. I'm serious in saying that had I not gotten relief from these shots I was pondering suicide.
I, for one, am extremely grateful for these shots being available. About 6 months ago, I injured my spine by doing some yardwork. (Note to self, no more breaking limbs from dead bushes under my foot!) After the MRI, I found out that I have stenosis (narrowing of the spine where the nerves are) and spondylosis (osteoarthritis of the spine).
I received the first epidural about 2 weeks after the initial injury. I had immediate relief. There were 2 injections - one at L2 and the other at L5. The relief lasted about a month or so before I started seeing the pain begin to return. I had my second epidural in September, and these injections were at L2 and L4. Again, I experienced immediate relief, and I am currently pain-free.
After the injury, I was sent to a sports medicine clinic for therapy, which included stretching exercises and a 10-minute warmup on a stationary bicycle. I also had traction, which gave me some much-needed relief. A few months ago, I purchased an inversion table, which also helps to relieve pressure on my spine. I have continued to do my exercises at my gym.
As some posters have mentioned, I believe Dr. Caplan, (PhD.), paints back pain with too broad a brush. I think that patients need to have a complete assessment of their particular situation and treatment plan with a doctor they trust before starting any treatment, regardless of how severe the situation may be.
While I agree that we, as a rule, tend to be overweight (myself included), I believe that should not always be a determining factor in the type of treatment offered. In my case, one of the doctors in the orthopedic practice was ready to jump right in and perform surgery on my back to remove portions from three sections. (The procedure is called a laminectomy.) The pain management doctor in that practice believed that I could avoid surgery with the epidurals. So far, that has proven to be the case.
While I know that my stenosis and spondylosis are going to remain with me, I believe that the course of action taken was right for me. I only hope and pray that I don't wind up at NYU, needing relief from back pain, and Dr. Caplan (PhD.) isn't the one who gets to decide what kind of treatment I receive.
Try acupuncture. I had severe sciatic pain that developed around 20 weeks pregnant-could barely walk most days-and after two acupuncture treatments, I was back to aerobics and weight lifting until 2 days before I delivered!
A GREAT article. Thank you. This is why wellness programs are so important. For many of us, it is very difficult to lose weight, eat better and exercise more on our own - we need help. As a way to treat the root cause instead of the symptom, wellness programs should be part of a doctor's prescription/referral repertoire. Instead of the Dr. just saying "you need to lose weight, eat better and exercise more" they need to say "you need to lose weight, eat better and exercise more. Here, I'm giving you a referral to enroll in a wellness/coaching program to help you do that, and I'll see you in 6 weeks to see how things are going". Now that's HEALTH care.
Blame the victim! And let's not forgot all the people who die from internal bleeding due to NSAIDs.
Each person's situation is unique. In 2007 I had steroid injections in my back due to severe pain and leg numbness caused by a herniated disc. I had the first set of injections, about 2-3 weeks later the second set, and after that I felt like a new person. I had such improvement, I didn't even need the third set of injections. I was 47 at the time, and after the steroid injections, I felt better than I did when I was in my 20s. For me it worked, and I have not had back pain since. I am also careful not to do anything stupid anymore like lifting heavy furniture, which I had been doing and which I am sure made the herniation worse. Also, trying to keep at a decent weight and not get overweight helps as well as exercise at least a few times a week (I joined a health club and go swimming). I know steroid injections don't work for everybody but I have nothing but good to say about my own experience with them.