Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms

Bruijn, Thomas M de; Groot, Ingrid B de; Miedema, Harald S.; Haumann, Johan; Ostelo, R.W.J.G.

doi:10.1097/ajp.0000000000000943

Cited by 13 publications

(17 citation statements)

References 69 publications

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“…Short‐ or middle‐term benefits may be valuable in patients with high levels of pain, disability and pain‐related distress. However, a recent systematic review and meta‐analysis focusing on the clinical relevance of ESI effectiveness found that only 4 of 17 studies detected clinically relevant effects, and the certainty of the evidence was either low or very low (de Bruijn et al, 2021). In a large study on the Medicare population, the rate (95% CI) of serious spinal adverse events probably associated with lumbar ESI was estimated at 5.1 (2.3 to 11.0) per one million (Eworuke et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Long‐term effectiveness of epidural steroid injections after new episodes of low back pain in older adults

Curatolo

Rundell

Gold

et al. 2022

European Journal of Pain

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Background There is limited research on the long‐term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: (1) have worse pain, disability and quality of life (‘outcomes’) pre‐ESI, (2) have improved outcomes after ESI and (3) have improved outcomes due to a specific ESI effect. Methods We prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3‐, 6‐, 12‐ and 24‐month follow‐ups. We categorized participants as: (1) ESI within 6 months from the index visit (n = 295); (2) no ESI within 6 months (n = 4809); (3) no ESI within 6 months, propensity‐score matched to group 1 (n = 483). We analysed the data using linear regression and Generalized Estimating Equations. Results Pain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24 months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between outcome trajectories for the propensity‐score matched groups 1 and 3. Conclusions Older adults treated with ESI have long‐term improvement. However, the improvement is unlikely the result of a specific ESI effect. Significance In this large, two‐year, prospective study in older adults with a new episode of low back pain, back pain, leg pain, disability and quality of life improved after epidural steroid injections; however, propensity‐score matching revealed that the improvement was unlikely the result of a specific effect of the injections, indicating that epidural steroids are unlikely to provide long‐term benefits in older adults with new episodes of back and leg pain.

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Section: Discussionmentioning

confidence: 99%

Long‐term effectiveness of epidural steroid injections after new episodes of low back pain in older adults

Curatolo

Rundell

Gold

et al. 2022

European Journal of Pain

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“…Injections on Lumbosacral Radicular Syndrome-related Symptoms: Systematic Review and Meta-analysis. 2 They are of the opinion that we did not evaluate technical quality and that our systematic review (SR) includes numerous methodological and foundational weaknesses. We will respond to these comments in this letter.…”

Section: Regarding Our Study Clinical Relevance Of Epidural Steroidmentioning

confidence: 99%

Authors’ Response to Letter to the Editor of Van Boxem et al Titled “Systematic Review on Epidural Steroid Injections: Quo Vadis?”

Bruijn

Groot

Miedema

et al. 2022

The Clinical Journal of Pain

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“…We thank McCormick and colleagues for their thorough comments 1 to our study Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Symptoms: Systematic Review and Meta-analysis. 2 Their comments are summarized in 4 key points, to which we will respond systematically: (1) 3 The protocol of our review was registered in PROSPERO (CRD42018115779). We included all studies that were identified with our search and fulfilled the eligibility criteria for inclusion in our review.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Symptoms

Bruijn

Groot

Miedema

et al. 2021

The Clinical Journal of Pain

Self Cite

View full text Add to dashboard Cite

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Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms

Abstract: Supplemental Digital Content is available in the text.

Cited by 13 publications

References 69 publications

Long‐term effectiveness of epidural steroid injections after new episodes of low back pain in older adults

Long‐term effectiveness of epidural steroid injections after new episodes of low back pain in older adults

Authors’ Response to Letter to the Editor of Van Boxem et al Titled “Systematic Review on Epidural Steroid Injections: Quo Vadis?”

Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Symptoms

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