A Controlled Trial of Corticosteroid Injections into Facet Joints for Chronic Low Back Pain

Carette, Simon; Marcoux, Sylvie; R, Truchon; Grondin, Charlotte; Gagnon, Jacques; Allard, Yves; Latulippe, Marie

doi:10.1056/nejm199110033251405

Cited by 481 publications

(333 citation statements)

References 17 publications

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“…Lilius et al [26], reported 'few' side effects but do not specify what they were. Carette et al [27], report some localised pain near injection site. Ribeiro et al [31] report adverse events, noting there were no significant differences between groups.…”

Section: Conservative Treatmentsmentioning

confidence: 99%

“…We included six trials with a total of N = 434 participants (range 18-109 participants); Lilius [26], Carette [27], Mayer [28], Celik [29], Kawu [30] and Ribeiro [31].…”

Section: Included Studiesmentioning

confidence: 99%

“…Two trials (Carette [27], Mayer [28]) included a diagnostic injection, into the facet joints, one trial, (Ribeiro [31]) used a combination of clinical and radiological assessment. The remaining three Lilius [26], Celik [29], and Kawu [30] used a clinical assessment only.…”

Section: Included Studiesmentioning

confidence: 99%

“…Two trials Lilius [26] and Carette [27] used intra-articular saline as a placebo control, whilst Ribeiro [31] used active injections into para-spinal muscles as a sham control.…”

Section: Sham/placebo Controlsmentioning

confidence: 99%

“…Two of the trials included a sample size calculation for their primary outcomes (Carette [27], Ribeiro [31]). Reason for incomplete follow-up was not reported in one study (Carette [27]), four studies had no loss at follow-up (Lilius [26], Mayer [28], Celik [29], Kawu [30]), one study (Ribeiro [31]) reported four dropouts, three missed followup and one, in the intervention group, died (not related to study).…”

Section: Conservative Treatmentsmentioning

confidence: 99%

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Intra-articular facet joint injections for low back pain: a systematic review

et al. 2016

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PurposeEvidence supporting the use of therapeutic intra-articular facet joint injections for patients with suspected facet joint pain is sparse. A systematic review including a narrative synthesis was carried out to determine if intra-articular facet joint injections with active drug are more effective in reducing back pain and back pain-related disability than a sham procedure or a placebo/inactive injection. Secondly, to determine if intra-articular facet joint injections with active drug or placebo/inactive injection are more effective in reducing back pain and back pain-related disability than conservative treatment. Methods Medline, EMBASE, CINAHL, CENTRAL, Index to Chiropractic Literature and the Cochrane Central Register of Controlled Trials were searched from inception through April 2015. Data were screened and single extraction with independent verification and risk of bias assessment was performed. Results A total of 391 records were screened, and six trials were included. The trials included were small (range 18-109 participants) and overall in terms of pain and disability outcomes most were inconclusive. Only two of the trials report any significant between-group differences in pain (mean difference -1.0, 95 % CI -2.0 to -0.1) and (p = 0.032) or disability (mean difference -3.0, 95 % CI -6.2 to 0.2) and (p = 0.013) outcomes. Conclusions The studies found here were clinically diverse and precluded any meta-analysis. A number of methodological issues were identified. The positive results, whilst interpreted with caution, do suggest that there is a need for further high-quality work in this area.

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Section: Conservative Treatmentsmentioning

confidence: 99%

“…We included six trials with a total of N = 434 participants (range 18-109 participants); Lilius [26], Carette [27], Mayer [28], Celik [29], Kawu [30] and Ribeiro [31].…”

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

“…Two trials Lilius [26] and Carette [27] used intra-articular saline as a placebo control, whilst Ribeiro [31] used active injections into para-spinal muscles as a sham control.…”

Section: Sham/placebo Controlsmentioning

confidence: 99%

Section: Conservative Treatmentsmentioning

confidence: 99%

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Intra-articular facet joint injections for low back pain: a systematic review

et al. 2016

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Back Pain: The History and Physical Examination-Reply

Deyo¹

1993

JAMA

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Users' Guides to the Medical Literature

Guyatt¹,

Bass²,

Brill-Edwards³

et al. 1993

JAMA

802

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for the Evidence-Based Medicine Working Group CLINICAL SCENARIO You are working as an internal medicine resident in a rheumatology rotation and are seeing a 19-year-old woman who has had systemic lupus erythematosus diagnosed on the basis of a characteristic skin rash, arthritis, and renal disease. A renal biopsy has shown diffuse proliferative nephritis. A year ago her creatinine level was 140 \g=m\mol/L, 6 months ago it was 180 \g=m\mol/L, and in a blood sample taken a week before this clinic visit, 220 \g=m\mol/L. Over the last year she has been taking prednisone, and over the last 6 months, cyclophosphamide, both in appropriate doses.

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A Controlled Trial of Corticosteroid Injections into Facet Joints for Chronic Low Back Pain

Abstract: We conclude that injecting methylprednisolone acetate into the facet joints is of little value in the treatment of patients with chronic low back pain.

Cited by 481 publications

References 17 publications

Intra-articular facet joint injections for low back pain: a systematic review

Intra-articular facet joint injections for low back pain: a systematic review

Back Pain: The History and Physical Examination-Reply

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