Tender point injection of corticosteroid in the treatment of backache

Summary

The cost of back pain in terms of morbidity and fall in income to patients, and loss of manpower to industry is remarkably high: it has been estimated that half the population has or has had backache. Thus a simple and efficacious treatment has been much sought after.

A series of 115 patients with chronic backache seen in general practice over a period of 10 years was reviewed. They had all been treated with injection of corticosteroid in lignocaine to tender spots on the back. The men showed a progressive incidence of backache to their fifties, with reducing incidence in retirement, while the women had an even spread through all ages from puberty. The proportion responding to treatment was similar for all age groups and was unrelated to length of history. A good response to injection was reported by 54% of patients overall, but this was reduced to 41% if prolapsed disc had been diagnosed on x-ray.

A second series of 57 patients with backache was investigated on a single-blind, randomised, controlled basis. Three groups were compared: lignocaine injection only, lignocaine with triamcinolone acetonide, and lignocaine with methylprednisolone acetate. There was no statistical difference between the two forms of corticosteroid, but there was a significantly greater benefit (p=0.001) from corticosteroid injection to tender spots in the back than from lignocaine injection alone.