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:

No light in the fog of back pain research

Cohen's editorial is interesting and his conclusions seem reasonable.
However two points undermine his whole argument, and his route to these

Firstly as mentioned in Watson's rapid response to this article the
terms back pain,neuropathic back pain and radiculopathy are used
interchangeably. To what does the term neuropathic back pain even refer?

Secondly his argument that one third of back pain is neuropathic, is
based on the findings of a German study 1 which seems flawed. They
employed a seven question self administrered questionnaire, apparently
validated in people with post herpetic neuralgia, to diagnose 'neuropathic
back pain'. Of the seven questions only the first three could be said to
have any likely specificity for neuropathic pain, the rest being non
specific or even in my view helpful in diagnosing back pain of mechanical

Whether effective or not epidural steroid injections are used to
treat radicular leg pain and possibly spinal stenosis; basing an article
on the efficacy of epidurals on such dubious findings does not help clear
the fog of evidence to date.

1 Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new
screening questionnaire to identify neuropathic components in patients
with back pain. Curr Med Res Opin2006;22:1911-20.

Competing interests: No competing interests

27 September 2011
Alasdair Jacks
Musculoskeletal Physician
Aneuryn Bevan Health Board