When long ago our ancestors made the leap from crawling around the ground to standing and walking, who would have thought that back pain would for many of us be the result?

Back pain is one of the most common and difficult problems to treat. Most of us at some point in our lives will suffer from at least one bout of it. For those unfortunate enough to have chronic severe back pain, options are becoming fewer and fewer.

Surgery is often offered to those who have certain conditions such as a herniated disc. However, it turns out that surgery is usually no better than traditional nonsurgical treatment. And of course surgery is expensive, has some significant risks and a long recovery period.

What about epidural injections? These have been touted to work and are much less risky than surgery. The theory is that the injected steroid reduces the inflammation around the spinal nerves, which in turn decreases pain. Sounds great, because steroids do reduce inflammation. However, a recent large, well designed study suggests otherwise.

In this study patients were given epidural injections with either a steroid and Lidocaine (a local anesthetic with no known antiinflammatory properties) or just Lidocaine. Those given just Lidocaine did as well as those who received the standard steroid and local anesthetic. What this means is that epidurals are no better than just injecting Lidocaine. What is not known is whether maybe the Lidocaine, the swelling caused by the injection or just the placebo effect are in play.

So if epidural injections are that great, what then is left? Medications such as Ibuprofen and Tylenol work reasonably well, but often don’t relieve severe pain. Narcotics are perhaps are short term answer but long term chronic pain medications are dangerous, relatively ineffective and expensive. Physical therapy, acupuncture, Yoga and other exercises may work. Weight loss helps.

Unfortunately, at least for the present, there is no miracle cure for chronic back pain.