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Epidural steroid injections are one of the most widely used nonsurgical treatments prescribed for low back pain and leg pain. They are effective to treat mild to moderate back pain, and their safety is proven by many small series. But there is mounting evidence suggesting that these surgical procedures may cause lasting nerve damage, leading to long-term disability. A growing number of researchers are calling for a rethink of the approach, but a number of physicians don't support the surgery. A paper published in the journal BMC Musculoskeletal Disorders is the first to highlight evidence from a large observational cohort, as well as data from a large trial conducted in Europe. The researchers' study of more than 5,200 patients, which included 1,918 low-back pain patients in the United Kingdom, revealed that men who experienced low back pain between the ages of 40 and 70 had higher rates of nerve damage than men who did not suffer from low back pain. Those who experienced high back pain experienced an even larger increase in nerve damage. And nerve damage was more likely to occur with long-term use of a nonsurgical treatment compared with surgery or the use only of a short-acting medication, known as a transdermal patch. "Although we can't draw any conclusions at this point about long-term outcomes, a big part of this is probably down to age," said lead researcher David Prentice, research fellow at the Institute of Psychiatry and Psychotherapy, King's College London. "I think it's possible that it's an ageing phenomenon, but we need to do more research to find out if it is the cause or merely an effect." The findings are significant from a patient perspective because they suggest there will be consequences for those using surgery to treat low back pain for a longer period, he said. "There will be fewer [patients] using the patch, which is a nice thing because it's going to take this pain away from many people," Prentice said. "But I think it's important that you really talk about the long-term effects [of low back pain], and I think this will be helpful in that regard." Prentice said that he and colleagues are likely to start working on further projects to explore the role of low back pain and other health conditions in the development of nerve damage after surgery. While a number of physicians have begun to suggest that long-term use of other treatments, such as acupuncture and psychotherapy, could be more viable alternatives to nonsurgical approaches, their use has not been as widespread as their use for back pain. "For many, the surgical Similar articles: