Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

Iversen, Trond; Solberg, Tore; Romner, Bertil; Wilsgaard, Tom; Twisk, Jos; Anke, Audny; Nygaard, Øystein P.; Hasvold, Toralf; Ingebrigtsen, Tor

doi:10.1136/bmj.d5278

Cited by 118 publications

(181 citation statements)

References 73 publications

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“…Three caudal injections of 20 ml bupivacaine 0.25% + 80 mg methylprednisolone. Iversen 67 RCT P DB 116 patients with lumbar radiculopathy >12 wk.…”

Section: Control Group Outcome Measures Results Commentsmentioning

confidence: 99%

“…When global pain ratings were not available for aggregate analysis, leg pain ratings were used in their place. 37,52,[65][66][67][68][69] Baseline and comparison data were the most recent data points available before and after the first injection (or injection series), respectively. All comparison data were observed within 12 weeks of the initial injection (if the injection scheme was open-ended) or after the final injection in the first injection series.…”

Section: Discussionmentioning

confidence: 99%

“…67,81,83 Both injections were examined in one study of high methodological and technical quality with 130 patients using four "control" groups. In this study 81 the proportion of patients with 50% or more pain relief was not significantly different among all comparison groups: 7% for transforaminal local anesthetic, 19% for transforaminal saline, 21% for intramuscular steroids, and 13% for intramuscular saline.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…In the systematic review, 43 studies provided data for ESI treatment and control groups representing 3,641 patients 37,52,[65][66][67][68][69] ( fig. 2).…”

Section: Systematic Reviewmentioning

confidence: 99%

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Epidural Injections for Spinal Pain

et al. 2013

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Background: Epidural steroid injection is the most frequently performed pain procedure. This study of epidural steroid "control" injections aimed to determine whether epidural nonsteroid injections constitute a treatment or true placebo in comparison with nonepidural injections for back and neck pain treatment. Methods: This systematic review with direct and indirect meta-analyses used PubMed and EMBASE searches from inception through October 2012 without language restrictions. Study selection included randomized controlled trials with a treatment group receiving epidural injections of corticosteroids or another analgesic and study control groups receiving either an epidural injection devoid of treatment drug or a nonepidural injection. Two reviewers independently extracted data including short-term (up to 12 weeks) pain scores and pain outcomes. All reviewers evaluated studies for eligibility and quality.Results: A total of 3,641 patients from 43 studies were included in this systematic review and meta-analysis. Indirect comparisons suggested epidural nonsteroid were more likely than nonepidural injections to achieve positive outcomes (risk ratio, 2.17; 95% CI, 1.87-2.53) and provide greater pain score reduction (mean difference, −0.15; 95% CI, −0.55 to 0.25). In the very limited direct comparisons, no significant differences were noted between epidural nonsteroid and nonepidural injections for either outcome (risk ratio Conclusion: Epidural nonsteroid injections may provide improved benefit compared with nonepidural injections on some measures, though few, low-quality studies directly compared controlled treatments, and only short-term outcomes (≤12 weeks) were examined.[

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“…Three caudal injections of 20 ml bupivacaine 0.25% + 80 mg methylprednisolone. Iversen 67 RCT P DB 116 patients with lumbar radiculopathy >12 wk.…”

Section: Control Group Outcome Measures Results Commentsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

“…In the systematic review, 43 studies provided data for ESI treatment and control groups representing 3,641 patients 37,52,[65][66][67][68][69] ( fig. 2).…”

Section: Systematic Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Epidural Injections for Spinal Pain

et al. 2013

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“…A blinded randomized control trial by Iversen et al published in 2011 found CESI to not be effective in treating chronic (>12 weeks) lumbar radicular pain with their results showing no statistical or clinical difference between sham groups and groups who received CESI [128]. Their study was slightly underpowered.…”

Section: Efficacymentioning

confidence: 99%

Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options

2015

J Orth Rheumatol

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Background: In the United States, low back pain remains a common problem and a number one reason to see a physician in the outpatient setting. Etiology is complex and likely multifactorial and includes; degenerative disc disease, zygapophysial joint arthritis, vertebral misalignment, muscle strain, ligament sprain, myofascial pain, among others. Based on evidence of increased inflammatory response in disc herniation and degenerative discs, epidural steroid injections (ESI) have been used to treat lumbosacral radicular pain. Objective:To focus on the appropriate use of lumbar ESI in treating lumbosacral radicular pain in the United States, comparing and contrasting transforaminal, interlaminar, and caudal approaches for steroid delivery, as well as a comparison of commonly used steroid preparations.Methods: PubMED, MEDLINE, and OVID databases were reviewed utilizing the following subject headings: low back pain, epidural steroid injections, transforaminal epidural steroid injections (TFESI), interlaminar epidural steroid injections (ILESI), and caudal epidural steroid injections (CESI) dated from 2000 to 2014. The bibliographies of major articles and reviews were also cross-referenced for additional sources.Results: A number of articles that included randomized control trials, comprehensive and systematic reviews, and meta-analyses were found. These provided a broad, detailed overview of the subject, that we used to explore the data surrounding use of ESI for treatment of lumbosacral radicular pain. Conclusions:Most agree that the evidence for epidural steroid injection efficacy is strongest for short term relief of lumbosacral radicular pain. Most of the systemic reviews have agreed that the strongest evidence for TFESI use is for relief of unilateral lumbosacral radicular pain. The evidence suggests using ILESI in patients with bilateral and/ or multi-level lumbosacral radicular pain. The data correlates efficacy of CESI in low level bilateral or multilevel lumbosacral radicular pain as well as in patients with history of lumbar surgery. Introduction EpidemiologyIn the United States, low back pain remains common. Approximately two-thirds of the population has low back pain at some time in their lives and approximately 26% of adults surveyed admit to having low back pain within the last three months [1]. Back pain is the fifth most common reason for all physician visits [2] and the second most common symptom-related reason for clinician visits [3,4]. The 2010 Global Burden of Disease (GBD) results showed that there is a very high prevalence and burden from low back pain throughout the world [5]. Low back pain was found to have the sixth highest burden of the 291 conditions studied, and caused more disability than any other condition. It is well known that back pain accounts for a large proportion of health care expenditures and that these expenditures have been increasing substantially [6]. In fact, these expenditures have been increasing more rapidly than overall health expenditures [6]. Taken together ...

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