In Reply Dr Kennedy and colleagues agree that overuse of injection therapy is a concern but disapprove of our claim of insufficient evidence to support the use of spinal injection therapy in low back pain. In their view, our article disregarded heterogeneity of studies. They argue that injections are useful when targeted toward specific spinal disorders.
Although the latter assertion is clinically intuitive, it also implies availability of accurate tests that enable clinicians to identify specific anatomic structures as the source of pain (eg, facet joints, intervertebral disks). However, the usefulness of these tests for guiding treatment selection in practice is unclear,1 and it remains challenging to prove that specific interventions are effective in specific subgroups of patients.
Staal JB, Nelemans PJ, De Bie RA. Use of Spinal Injections for Low Back Pain—Reply. JAMA. 2013;310(16):1736-1737. doi:10.1001/jama.2013.277996