A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study

Arden, N K; Price, Cathy; Reading, Isabel; Stubbing, J.F.; Hazelgrove, J; Dunne, Casey E.; Michel, M.; Rogers, Peter; Cooper, Cyrus

doi:10.1093/rheumatology/kei028

Cited by 194 publications

(176 citation statements)

References 29 publications

Supporting

Mentioning

161

Contrasting

Unclassified

Order By: Relevance

“…Chou et al [19] have suggested that trials comparing epidural saline or anesthetic injection versus non-epidural placebo injection would be helpful to clarify the efficacy of non-steroid epidural injections. This recommendation is particularly important since the epidural steroid injected as an intervention is often diluted in saline or in anesthetic [4,12,36,69].…”

Section: Discussionmentioning

confidence: 99%

Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety

2011

View full text Add to dashboard Cite

Introduction Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs. Moreover, a few neurological adverse events have been reported recently. Methods A literature search of systematic reviews analysing the effectiveness and complications of ESIs was carried out. The scientific quality of the reviews was assessed using the validated index of Oxman and Guyatt. We relied on data abstraction and quality ratings of the placebo-controlled trials as reported by high-quality systematic reviews. Results Two types of systematic reviews were found. The Cochrane high-quality systematic reviews combining the three approaches and different pathologies were predominantly non-conclusive. The second type of review, emanating from the US Evidence-based Practice Centers, distinguishing between the routes of administration and between the principal pathologies found a moderate shortterm benefit of ESIs versus placebo in patients with disc herniation and radiculitis, in keeping with the clinical experience. ESIs are generally well tolerated and most complications are related to technical problems. Cases of paraplegia, complicating the foraminal route and related to the violation of a radiculomedullary artery, have been recently reported. They are predominantly observed in previously operated patients. Conclusions Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety

2011

View full text Add to dashboard Cite

show abstract

“…Epidural steroid injection has been commonly used as a non-surgical treatment for radicular pain (Bogduk et al, 1994;Goebert et al, 1961). While a number of open-label clinical studies have shown the beneficial effects of epidural steroid injection (e.g., Spaccarelli et al, 1996), several prospective, randomized, controlled studies have failed to provide convincing evidence for its clinical efficacy (Armon et al, 2007;Carette et al, 1997;Arden et al, 2005;Price et al, 2005;Valat et al, 2003). To date, it remains unclear with regard to the clinical efficacy of epidural steroid injection for the treatment of radicular pain (Armon et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Time-dependent effect of epidural steroid on pain behavior induced by chronic compression of dorsal root ganglion in rats

Wang

Yang

et al. 2007

Brain Research

View full text Add to dashboard Cite

Although epidural steroid injection has been commonly used to treat radicular pain, its clinical efficacy remains controversial. In a rat model of radicular pain induced by chronic compression of lumbar dorsal root ganglion (CCD), we examined the effect of epidural steroid on CCD-induced pain behavior. Triamcinolone [a glucocorticoid receptor (GR) agonist] or RU38486 (a GR antagonist) was given epidurally once either on day 3 (early treatment) or day 10 (late treatment) after CCD. The results showed that 1) early treatment with triamcinolone and RU38486 alone, respectively, reduced and exacerbated mechanical allodynia and thermal hyperalgesia, 2) late treatment with triamcinolone alone failed to improve mechanical allodynia and only transiently attenuated thermal hyperalgesia, and 3) late treatment with RU38486 alone improved mechanical allodynia and thermal hyperalgesia in CCD rats. Moreover, a second dose of triamcinolone given on day 10 paradoxically exacerbated pain behavior in CCD rats that received a first dose of triamcinolone on day 3. These results indicate that the effect of epidural steroid on radicular pain may be time-dependent. Clinical implications for epidural steroid treatment are discussed in light of these preclinical findings.

show abstract

“…One such review exploring efficacy of interlaminar lumbar injections concluded strong evidence for short-term pain relief and limited benefit for long-term benefit [73] citing, among many, randomized controlled trials (RCT) by Arden and Carette of unilateral sciatic pain, finding statistically significant improvement in up to 75% of patients with steroid/anesthesia versus saline injections at 3 weeks, with benefit waning by 6 weeks and 3 months, respectively [76,77].…”

Section: Injection Therapy Epidural Steroid Injectionsmentioning

confidence: 99%

Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches

Gupta¹,

Attry²,

Vashisth³

et al. 2016

IOSR

View full text Add to dashboard Cite

A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study

Cited by 194 publications

References 29 publications

Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety

Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety

Time-dependent effect of epidural steroid on pain behavior induced by chronic compression of dorsal root ganglion in rats

Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches

Contact Info

Product

Resources

About