Questioning Steroids for Back Pain

So a new study shows that injecting epidural saline is just as good as injecting steroids for low back pain.  I think this should be a rather big deal.
This study was painstakingly done reviewing all appropriate studies to date, even taking into account publication bias. The full study here.Epidural_Injections_for_Spinal_Pain__A_Systematic.31
A handy review of what they found is here

What We Already Know about This Topic
• Epidural nonsteroid injections (primarily local anesthetics) may
provide treatment for neuropathic pain via several potential
mechanisms
What This Article Tells Us That Is New
• This systematic review of the literature found that the few
available trials directly comparing epidural nonsteroid with
nonepidural injections showed no benefit
• Indirect comparisons of the techniques from a larger number
of trials suggested epidural nonsteroid injections may confer
some benefit

Having just experienced the excruciating standards for acupuncture studies, the need for appropriate control arms to distinguish effect from nonspecific effects and placebo, this study underscores what I refer to as “the tyranny of the model.”  Meaning, if a treatment makes sense according to current paradigms it is embraced.  Epidural steroids have been injected into patient’s epidural spaces for over 50 years, yet it turns out no steroids would have been just as effective (safer) and probably non epidural injections (safer still) and perhaps acupuncture too (safest.)  This falls into the category of “believing in treatments that don’t work.”  Need I remind people of the meningitis cases from a few years ago??
A discussion follows though I don’t think it’s entirely accurate.

Questioning Steroid Shots for Back Pain