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  • Injecting steroids into the area around the spinal cord, known as an epidural, is the most commonly used treatment for back pain, but a new review of studies suggests that injecting any liquid, even plain saline solution, works just as well.

    Researchers pooled the results of 43 studies involving more than 3,600 patients who got various kinds of injections for back pain. As they expected, they found some evidence that epidural steroid injections provided more relief than steroid injections into the muscles.

    But the study, published online in Anesthesiology, also found that there was little difference between the amount of relief provided by steroidal and nonsteroidal epidural injections.

    The researchers suggest that any liquid injected epidurally can help reduce inflammation, enhance blood flow to the nerves and clean out scar tissue.

    “Epidural steroid injections may provide modest relief for up to two months in people with back pain due to nerve inflammation,” said the senior author of the study, Dr. Steven P. Cohen, a professor of anesthesiology at Johns Hopkins.

    But steroids have side effects, and “most of the short-term benefit seems to be not from the steroids, but from the local anesthetic and saline, which may ‘calm’ inflamed nerves that send pain signals,” said Dr. Cohen. “Doctors should consider significantly reducing the steroid dose, or even not using steroids in patients who are at high risk.”