Intended for healthcare professionals

Rapid response to:


Epidural steroid injections for low back pain

BMJ 2011; 343 doi: (Published 13 September 2011) Cite this as: BMJ 2011;343:d5310

Rapid Response:

Clear writing: clear thinking

The title of this editorial is "Epidural steroid injections for low
back pain", but in the first sentence Stephen Cohen mentions an article
looking at treatment for lumbar radiculopathy.

Then in the second paragraph he reverts back to the term "low back

Patients with non-specific low back pain can be distinguished from
patients with possible nerve root irritation (often called radiculopathy
) by asking the question "Do you also have leg pain?"

In the morass of uncertainty that surrounds this subject we can
agree, surely, on this subdivision. And we can (and should) then look at
these two easily-separable patient groups separately.

The uncertainty of what group of patients is being discussed is
highlighted by the use of the term "neuropathic low back pain".
I do not know what this term means.
I assume "neuropathic", in this context denotes lumbar nerve root
irritation. But nerve root irritation produces (predominantly) leg pain.
Therefore, I assume that patients with neuropathic low back pain must also
have leg pain, but is this assumption correct?

Careful use of terms that cannot be misunderstood is surely essential
in any article on low back pain with or without nerve root irritation.

Competing interests: No competing interests

23 September 2011
Dr.Andrew Watson
orthopaedic physician
Pain Management Solutions