Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice

Abstract

BackgroundLumbosacral radicular syndrome (LRS) is a self-limiting, benign, painful and impairing condition caused by lumbar disc herniation and inflammatory processes around the nerve root. Segmental epidural steroid injections (SESIs) are helpful to reduce radicular pain on a short-term basis. It is unknown whether SESIs are an effective addition to usual pain treatment of LRS in general practice. In our study, we assessed the effectiveness of SESIs on pain and disability as an addition to usual care for acute LRS in general practice.MethodsA pragmatic, single-blinded, randomized controlled trial in Dutch general practice was conducted. Circumstances of daily practice were closely followed. Care as usual (CAU) was compared to care as usual combined with an additional SESI in 63 patients in the acute phase of LRS. To detect a minimal clinically important difference of 1.2 points on a numerical rating scale for back pain and a common within-group standard deviation of 1.7 with a two-tailed alpha of 0.05 and a power of 0.80, we needed 33 subjects in each group. Statistical analysis was carried out using mixed models.ResultsA small significant effect in favour of the intervention, corrected for age, sex and baseline values, was found for back pain, impairment and Roland-Morris disability score. The differences, though statistically significant, were too small to be considered clinically relevant. Patients from the intervention group were significantly more satisfied with the received treatment than patients from the control group.ConclusionWe found a small, statistically significant, but not clinically relevant positive effect of SESIs on back pain, impairment and disability in acute LRS. We do not recommend implementing SESIs as an additional regular treatment option in general practice.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-341) contains supplementary material, which is available to authorized users.

Transforaminal epidural injection versus continued conservative care in acute sciatica (TEIAS trial): study protocol for a randomized controlled trial

“…However, only few studies have investigated the use of TEI specifically in patients with acute sciatica (< 8 weeks). One study randomized 63 patients with a duration of symptoms between 2 and 4 weeks to either TEI or usual conservative care [11]. The TEI group experienced a greater improvement in functionality and back pain, but differences between groups were small.…”

“…Theoretically, this treatment would enable the patient to remain physically active while awaiting spontaneous recovery. Although its use is widespread, some patients experience a beneficial effect while others report no effect at all or only initial pain relief followed by recurrence of pain after several hours, days or weeks [11, 12]. In the Netherlands some hospitals offer TEI as standard care for sciatica but usually only after 14–16 weeks of conservative therapy.…”

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

“…Also, SpijkerHuiges et al 29 found a statistically significant effect of segmental epidural steroid injections on back pain, impairment and disability in acute lumbosacral radicular syndrome and patients from the intervention group were significantly more satisfied with the treatment received than patients from the control group. Moreover, Kim et al 30 found that repeated RF neurotomy for lumbar facet joint pain after microscopic discectomy is an effective palliative treatment and provided a mean duration of relief of 9.0 months and > 94% success rate.…”

Do Corticosteroids Still Have a Place in the Treatment of Chronic Pain?

“…With respect to their inadequate efficacy in decreasing low back pain, focus has been shifted from the use of oral corticosteroids to epidural steroid injections. Furthermore, the evidence has demonstrated that the use of steroid injections alone or in combination with other modalities has improved symptoms, treatment satisfaction scores and cost-effectiveness in the management of low back pain ( Spijker-Huiges et al, 2014 , 2015 ). Spijker-Huiges et al (2014) demonstrated in a single-blinded, randomized controlled trial (RCT) improved treatment scores in a group of patients undergoing lumbar radicular syndrome treatment using segmental epidural steroid injections (SESIs) added to the usual pain treatments compared with control ( p = 0.006).…”

“…Furthermore, the evidence has demonstrated that the use of steroid injections alone or in combination with other modalities has improved symptoms, treatment satisfaction scores and cost-effectiveness in the management of low back pain ( Spijker-Huiges et al, 2014 , 2015 ). Spijker-Huiges et al (2014) demonstrated in a single-blinded, randomized controlled trial (RCT) improved treatment scores in a group of patients undergoing lumbar radicular syndrome treatment using segmental epidural steroid injections (SESIs) added to the usual pain treatments compared with control ( p = 0.006). Another RCT demonstrated a significant improvement regarding the quality of life in the physical domain of the SF-36 questionnaire among patients utilizing SESIs compared to a control group in the management of lumbosacral radicular syndrome ( Spijker-Huiges et al, 2015 ).…”