Cortisone Shots for Back Pain: A Deep Dive into Effectiveness

In this episode of 'Ask the Chiropractor,' Dr. Brant Hulsebus explores the effectiveness of cortisone shots for back pain and spinal conditions, referencing recent research from the American Academy of Neurology. He discusses short-term and long-term success rates for both radiculopathy and spinal stenosis, compares these to chiropractic solutions, and emphasizes the importance of considering chiropractic adjustments as a primary treatment option for acute lower back and neck pain. Tune in to learn about the research, statistics, and Dr. Hulsebus's professional insights on managing back pain effectively.

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Transcript

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Hello, Dr. Brant Hulsebus here and welcome to another edition of Ask the Chiropractor. Ask the Chiropractor is my little podcast that I do when someone has a question about chiropractic or chiropractic care, I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic and I'm happy to be the team chiropractor of the Rockford Icehogs. Let's dive into it. Hi, thank you for tuning in. Today's question has to do with epidural shots, cortisone shots. People ask me all the time, Hey, my back's been bothering me for a while, should I get a shot in my back? What do you think about getting a shot? Hey, I went to my doctor and they suggested I get a shot in my back or, I had an MRI and they're recommending me get a shot in my back. And today's pain management doctors, several of them, a lot of them give over 40 shots a day in people's backs. They just go around room to room doing this. It's very common practice. And so when I'm asked my opinion of cortisone shots, I like to talk about the research more than maybe my opinion, right? Because my opinion obviously is you got to give chiropractic a try. My opinion from that is formed because the research is abundantly obvious that chiropractic adjustments should be your number one choice for acute lower back pain and neck pain. There's just tons of research showing that this is the number one thing we should do. Even the World Health Organization recommends chiropractic care above anything else. But that's not how we do it in the States, right? In America we get that cortisone shot. And there's been a lot of research on this, and another research paper just came out. And I'd like to Take a couple minutes and educate everybody on the research paper. And you don't have to humor me this week, because this week I actually have my notes in front of me. Because this is a lot of cool data, a lot of cool information. And I don't want to mess it up. This came from the American Academy of Neurology. And what they did is they took 90 case studies, and they looked at the information, how it helped. And they looked at two different cases. A lot of people come to us because they have spinal pain or radiculopathy. What is radiculopathy? That means that my lower back hurts and it's traveling in the area. It could be down your leg, it could be in the general facility, but if there's back pain, it hurts more than just that one spot on my back. The second one is stenosis. Now, everybody has a spinal canal. Where your nerves go down. Your spinal cord goes down. It goes out of there to the rest of your body. And it's right along the spine surrounded by bony bridges. Stenosis is when this canal is being encroached. It's being crowded and the hole that should be this size is reduced in size and it's putting pressure on the nerves inside the spinal canal. I don't want to say spinal cord because the spinal cord ends in L1, L2. So if I said L4, I can't hit your spinal cord because you don't have a spinal cord there. It ended higher up. That's stenosis. Now, what they did is they did some short term and long term studies on this. They wanted to see how these cortisone shots work. And they have what they call a success rate difference, and they also have what they call a number needed to treat. Success rate differential. That is how many, how many people did they see until somebody got relief. And then the N and T number, the number needed to treat for success. It's a mirror image, right? Because, if it's you'll see. Let's talk about short term relief from radiculopathy pain with a cortisone shot. Their assesorate found that 24 percent of people had pain relief following the shot for short term. So that's one of, they need to treat four people before one person has relief. And then for disabled people, they reported that one out of every six said that their disability improved. For every four people that walk into the doctor's office and get a shot, only one of them has success when it comes to radiculopathy. One out of every twenty five percent, basically. That's what we're talking about. One out of every four. And then when we looked at the long term thing, it got less. After six months short term, it'd be like right now, we're getting rid of pain right now. Versus six months later, how are we doing? We found six months later that the SR, the SRD was 10%. So only one out of every ten had relief from radiculopathy. And of course, the number needed to treat was, they had to treat ten people to get one to be successful. So the long term of this was not so hot, right? Only one out of every ten. So when you have the cortisone shot, six months later, 90 percent of them are back where they started. Maybe this is why you're allowed three shots a year. The problem with the three shots a year is the literature is abundantly clear that cortisone shots will cause damage to the joints repetitively done over time. I had my shoulder surgery and I got a cortisone shot. Man, that feels great for my shoulder, because again, the spine and the shoulder are different things. The FDA has never approved the shots for the spine, but they do approve them for the shoulder. I got relief right away. I'm like, why don't we just keep doing this? And they basically told me, my orthopedic friend, who I trusted is a friend of mine, he said, after so many, you're going to whole rotator cuff will deteriorate. So there's no argument whether or not cortisone shots will eventually deteriorate the joint. So that's one of the problems with getting three shots a year. Let's summarize radicopathy here real quick. Short term, quick relief, I'm in a lot of pain, I get the shot. 25 percent of people would get relief for every four people that go in, only one's going to get relief. Six months later, after this is over, of that percentage of people who got relief, only one out of ten of them still has relief. That's a pretty small number when you think about it. When you think about, if you had a hundred people only 25. of them actually had success, and then six months later, only one out of every ten of them were still successful. So we're talking about three, two and a half people, three people, six months later, out of a hundred? Not very good odds. Let's talk about stenosis. So notice when they give the shot right away, short term again, we talked about the SRD, the Success Rate Differential, it's 26 percent, slightly higher. But, the other one was 24, this is 26 it's just going to say 25 percent. It takes four people to treat in order for one to get accessible, very similar to before. And this one, though, the people that were disabled, people who claimed disability, they're just, only 3 percent of them got better. So before it was one out of every six could go back to working afterwards, but only three percent of these ones could, so that's not very good. But let's talk about long term with these shots for the stenosis. Six months later, how are we doing? These numbers are not very good. 65 people still had relief six months later. So if you've been diagnosed with an MRI that shows you, by the way, MRI only way to know you have spinal stenosis. And even that's not awesome because you're laying down, not standing up. They don't have standing up MRIs because you can't move during your MRI so you have to lay down. But 65, that's not even 1%. You can run up to 1%. If you want to run up to 1 percent we can. So now talking about those big number pictures again, right? So if a hundred people go in, only 25 get relief, and only one of a hundred of them get better, so there's a chance that none of these people are better. You might have to do this 34 times to get 400 people to get one six months later. And that's only 0. 6 percent of that one even happening to get better. So stenosis, the idea of doing cortisone shots for stenosis, for long term relief, thinking that's going to work is statistically doesn't look very strong. But again, we found chiropractic adjustments with stenosis long term is amazing. Again, this is not a chiropractic research paper, this is the American Academy of Neurology. I will put a link to this paper wherever you're listening or hearing this so you can See it. Okay. So why is this so important to me as a chiropractor? I've hinted towards a little bit. 89 percent of adults at some point will have back pain. 89 percent of our population will have back pain at some time. And where are they going to go to get help? What are they going to do to take care of themselves? And have the most success and have the least problems down the road? If you read the research and you follow the literature, It discontinuously pushes what they call spinal manipulative therapy and in my world we call those chiropractic adjustments. The research comes back over and over again showing the success rate of what we do. And, the research also comes back and shows the lack of success other healthcare providers do. Now, should we get rid of these things? Probably not. For 25 percent of people, I mean if you've had really bad acute lower back pain where you can't walk, you can't get off a chair, and you're miserable, maybe this is good to take the edge off so you can go back to the chiropractor, right? If you hurt so much you can't make it to the chiropractic clinic, then maybe you need a shot like this so you can get back to the chiropractor. But let's say you do that. Let's say you get a cortisone shot, and then you want to go get a chiropractic adjustment. And you ask the orthopedic doctor or the pain management doctor, Hey, you gave me this shot. Is it okay if I go back to the chiropractor? That's a mistake. That's a mistake because the only people who know anything about chiropractic are chiropractors. So you're going to ask them that question. They're probably going to tell you no. This is just from clinical experience. They're going to tell you no. And then you're going to Three months down the road, four months down from the road, your pain's going to come back. And unless you're one of those lucky few people we talked about with the radiculopathy, you're going to be in trouble. It's going to come back and get you bad. And what are they going to do? Probably offer you another shot. So if you get a cortisone shot, you need to wait a few days after the cortisone shot, in my clinical experience, and then go see your chiropractor. Let your chiropractor determine whether or not you're ready for that. Chiropractic adjustments. Only the chiropractor can answer that question and you know as chiropractors we study this kind of things all the time. There's a success rate of other things. A lot of times we have a acute patient and we're, we know chiropractic is gonna work but it doesn't work always the first three visits. Sometimes it takes 10 visits. I did a podcast earlier about a different research paper that the research basically shows it takes 12 chiropractic adjustments to make a change. Now, does some get better faster? Yeah, some get better a little longer? Yeah, because that's an average number. But we're looking at the number 12 as our magic number before we can really say whether or not it's working or not working. So if you have a friend that said, I tried chiropractic, they went four times, didn't get any relief and quit. That's like me saying I tried a diet, I ate good for 4 days and I quit and I went back to eating junk food, therefore diets don't work. That's a ridiculous statement. And if a doctor tells you that chiropractics, you're not a good candidate for chiropractic care, by all means do not take their word. Go find a chiropractor. We have it all the time in this office. Somebody finally finds their way to us and they find out that they could have came and seen us a long time ago. So spinal radiculopathy, spinal stenosis, and cortisone shots. Hope I shared some cool information, gave you something to think about. And like I've stressed a thousand times before, if you have questions about chiropractic or chiropractic care, go find a chiropractor, ask them. They're the only ones, only ones, who actually know whether or not you should or should not be adjusted. Thank you.