Dr. Stefano Sinicropi, M.D.

In many clinical trials involving corticosteroid steroid injections for back pain, some participants receive the actual steroid injection while another group receives a placebo injection. This allows researchers to see the effects of the injection on two different groups, both of whom believe they received the actual drug. Oftentimes the placebo injection is just a simple saline solution composed of water and sodium chloride. It is not intended to have any actual impact on the spine, and researchers are hoping to see how the brain responds when it believes it has received the real medicine.

But recently, researchers have noticed something more striking than a placebo effect when it comes to reviewing the perceived success of corticosteroid injections and saline placebo injections for back pain. Patients in the saline group were claiming their back pain was improving at much more pronounced levels than would be expected in a placebo group. A closer look revealed that these patients didn’t just believe they were improving, they were actually experiencing physical improvement as a result of the saline injection.

Now, the improvement wasn’t overwhelming, and there’s no reason to think that a saline solution will be recommended over an injection that delivers anti-inflammatory medication directly to the source, but the results were still quite fascinating nonetheless.

Placebo Saline Spinal Injections

To learn more about the effects of saline on the spine, researchers conducted a systematic review and meta-analysis of 18 randomized controlled trials involving 759 patients who had received saline injections. Researchers were most interested in two kinds of back injuries:

• Lumbar radiculopathy – Pain caused by a pinched nerve in the spine.
• Discogenic pain – Pain caused by damage to intervertebral discs.

Researchers also noticed an improvement in patients with disc-related low back pain, but the effect size was less.

But why was saline actually helping some patients make physical improvements with their back pain? Researchers had some theories:

• Saline may reduce inflammation around an irritated nerve
• Saline may wash out inflammatory chemicals around an irritated nerve
• Patients may experience a positive feedback mechanism, where the saline contributes to inflammation relief, which allows participants to participate in rehab, physical therapy, exercise or normal activities, and this movement further aids in the recovery process.

So while a saline solution won’t be pitched as a proactive treatment for your spine issue, it may have a small positive effect on the back, and as a result may not be an ideal control substance for future studies on spine injections. If you’re looking for a way to manage or overcome your new or chronic back pain, connect with Dr. Sinicropi and the team at Midwest Spine & Brain Institute today at (651) 430-3800.

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