Individuals seeking care for back pain whose symptom pattern was typical of fibromyalgia derived little benefit from minimally invasive spine therapies such as epidural steroid injections, researchers found.
In recent decades the popularity of minimally invasive spine treatments has skyrocketed, with increases of more than 100% being reported for epidural steroid injections and of more than 500% for facet joint interventions such as injections and medial branch blocks. However, these procedures have high failure rates, with estimates ranging from 25% to 45%, and a recent meta-analysis found little long-term benefit for spine injections for sciatica.
It also has become clear that certain chronic pain conditions, most notably fibromyalgia, are characterized by alterations in centralized CNS pain processing, implying that local treatments are less likely to be successful. “Injections and peripherally targeted analgesics would be expected to provide less benefit in a patient with altered central pain processing than in those with predominantly peripheral pathology,” the researchers noted. Patients with fibromyalgia also typically have reduced levels of pain-inhibiting neurotransmitters such as serotonin and high levels of transmitters such as glutamate that can increase pain sensations.”
Taken together, these data make a compelling case for the study of a modified treatment approach.”Nonpharmacologic interventions, have also demonstrated excellent effect sizes that often exceed pharmacologic interventions in fibromyalgia and other pain states.”