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:

Radicular pain and axial back pain: Two unique entities

In his editorial piece, Cohen(1) seems to have been unable to
distinguish between different conditions and specifically between axial
back pain and radicular pain, which we feel are separate and unique
pathologic entities with their respective unique sequlae. We concur with
the sentiments expressed by Watson in his "Rapid Response" and feel that
the editorial title itself is misleading and thus provides, in our
opinion, an unbalanced perspective on a useful piece of work(2). We would
recommend adoption of a validated classification system such as the
Fairbank-Hall Classification(3) to distinguish between the different types
of lumbar spine pain. This would prevent confusion regarding which types
of pain are amenable to treatment with epidural steroid injection.


1.Cohen, S.P. Epidural steroid injections for low back pain BMJ

2.Iversen, T., Solberg, T.K., Romner, B., Wilsgaard, T., Twisk, J.,
Anke, A., Nygaard, ?., Hasvold, T., Ingebrigtsen, T. Effect of caudal
epidural steroid or saline injection in chronic lumbar radiculopathy:
multicentre, blinded, randomised controlled trial BMJ

3.Wilson, L., Hall, H., McIntosh, G., Melles, T. Intertester
reliability of a low back pain classification system. Spine. 1999 Feb

Competing interests: No competing interests

12 October 2011
Ibrar Majid
Orthopaedic SpR
James Childs, Manoj Khatri
Spinal Surgery Unit, Royal Preston Hospital