Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study

Cohen, Steven P.; Hanling, Steven; Bicket, Mark C.; White, Ronald L.; Veizi, Elias; Kurihara, Connie; Zhao, Zirong; Hayek, Salim M.; Guthmiller, Kevin; Griffith, Scott; Gordin, Vitaly; White, Mirinda Anderson; Vorobeychik, Yakov; Pasquina, Paul F.

doi:10.1136/bmj.h1748

Cited by 74 publications

(65 citation statements)

References 55 publications

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“…10–12 Prior to their conduct, all studies secured internal review board permission from every institution participating in patient recruitment, and all participants provided written informed consent. One study examined the impact of magnetic resonance imaging (MRI) on outcomes and decision making in patients referred for epidural steroid injection (ESI).…”

Section: Methodsmentioning

confidence: 99%

“…A total of 361 patients were randomized in three studies. 10–12 Among nine patients excluded from this analysis, five received non-study treatments and four were lost to follow up at 1 month.…”

Section: Methodsmentioning

confidence: 99%

“…10–12 These studies recruited patients with lumbosacral radiculopathy from both military and civilian hospitals. Patients underwent epidural injections, with most receiving steroid and some receiving sham, saline, or a cytokine inhibitor tumor necrosis factor (TNF)-α injection.…”

Section: Introductionmentioning

confidence: 99%

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Which Regional Pain Rating Best Predicts Patient‐Reported Improvement in Lumbar Radiculopathy?

2017

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Region-specific pain cutoff ratings predicted clinical improvement for patients with LSR. Cutoff points using newly identified, smaller reductions of 1.75 points and 23.5% more accurately predicted clinical improvement for LSR than conventionally used cutoffs (2 points and 30%). LSR patients report meaningful clinical improvement with smaller reductions in pain compared to other chronic pain diagnoses, suggesting LSR patients may have different expectations.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Which Regional Pain Rating Best Predicts Patient‐Reported Improvement in Lumbar Radiculopathy?

2017

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“…In contrast to footdrop, foot slap has a relatively minor impact on gait. Second line care may progress to more complex medications, including neuropathic pain medication and oral steroids; however, the efficacy of both interventions is unclear 42 . ‐ 44 Moreover, epidural injections of corticosteroids are considered controversial 45 .…”

Section: Diagnostic Triage For Primary Care Management Of Low Back Painmentioning

confidence: 99%

Diagnostic triage for low back pain: a practical approach for primary care

Bardin

King²,

Maher³

2017

Medical Journal of Australia

225

149

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Diagnostic triage is an essential guideline recommendation for low back pain (LBP), which is the most frequent musculoskeletal condition that general practitioners encounter in Australia. Clinical diagnosis of LBP - informed by a focused history and clinical examination - is the key initial step for GPs, and determines subsequent diagnostic workup and allied health and medical specialist referral. The goal of diagnostic triage of LBP is to exclude non-spinal causes and to allocate patients to one of three broad categories: specific spinal pathology (< 1% of cases), radicular syndrome (∼ 5-10% of cases) or non-specific LBP (NSLBP), which represents 90-95% of cases and is diagnosed by exclusion of the first two categories. For specific spinal pathologies (eg, vertebral fracture, malignancy, infection, axial spondyloarthritis or cauda equina syndrome), a clinical assessment may reveal the key alerting features. For radicular syndrome, clinical features distinguish three subsets of nerve root involvement: radicular pain, radiculopathy and spinal stenosis. Differential diagnosis of back-related leg pain is complex and clinical manifestations are highly variable. However, distinctive clusters of characteristic history cues and positive clinical examination signs, particularly from neurological examination, guide differential diagnosis within this triage category. A diagnosis of NSLBP presumes exclusion of specific pathologies and nerve root involvement. A biopsychosocial model of care underpins NSLBP; this includes managing pain intensity and considering risk for disability, which directs matched pathways of care. Back pain is a symptom and not a diagnosis. Careful diagnostic differentiation is required and, in primary care, diagnostic triage of LBP is the anchor for a diagnosis.

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“…A Level-I, prospective, randomized controlled trial comparing epidural corticosteroid injection with oral gabapentin for lumbosacral radiculopathy in military patients and veterans found that epidural corticosteroid injection provided greater benefit than gabapentin in the short term, but that the differences were modest and were not maintained by a 3-month follow-up 32 .…”

Section: Epidural Corticosteroid Injection Efficacymentioning

confidence: 99%

What’s New in Spine Surgery

Choma

Brodke

2016

The Journal of Bone and Joint Surgery

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Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study

Abstract: ObjeCtiveTo evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.

Cited by 74 publications

References 55 publications

Which Regional Pain Rating Best Predicts Patient‐Reported Improvement in Lumbar Radiculopathy?

Which Regional Pain Rating Best Predicts Patient‐Reported Improvement in Lumbar Radiculopathy?

Diagnostic triage for low back pain: a practical approach for primary care

What’s New in Spine Surgery

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