The Basis for Recommending Repeating Epidural Steroid Injections for Radicular Low Back Pain: A Literature Review

Novak, Suzanne; Nemeth, William C.

doi:10.1016/j.apmr.2007.11.008

Cited by 43 publications

(35 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…27,132 For example, increasing the depo-steroid dose of more than 40 mg appears to provide no added benefit, and there is little evidence that a series of ESI results in better outcomes than a single injection, or tailoring the number of injections to patient response. 27,[110][111][112]120,132,133 However, the conglomeration of these different factors (e.g., injection type and number, dose, volume) may have a cumulative effect, and hence limit the generalization of the meta-analyses. Third, publication bias may be present for studies that compared ESI and ENSIs, with modeling suggesting a nonsignificant outcome favoring ESI when a correction for small study effects was performed.…”

Section: Discussionmentioning

confidence: 99%

Epidural Injections for Spinal Pain

et al. 2013

View full text Add to dashboard Cite

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.[

show abstract

Section: Discussionmentioning

confidence: 99%

Epidural Injections for Spinal Pain

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Yet, ''there does not appear to be any evidence to support the current common practice of a series of injections.'' 58 An evidence-based review of a variety of interventional techniques in managing chronic spinal pain suggests that epidural steroid injections are at best ''limited in managing postlaminectomy syndrome and spinal stenosis.'' 59 Despite these findings more recent literature adds to the confusion by once again extolling caudal epidural injections.…”

Section: Epidural Steroidsmentioning

confidence: 99%

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

Seres

2009

Neurosurgery Quarterly

View full text Add to dashboard Cite

Surgery for common spinal disorders has changed dramatically in the last several decades. The failed surgical back syndrome patients populate a vast number of chronic pain clinics and rehabilitation facilities. New surgical procedures promise better outcomes. Yet documented improvement in imaging studies and the original promise of newer technologies have not consistently resulted in better clinical outcomes. More important than the technical success is the improved state of the patient. The search for the ''properly selected patient'' is a commonly used euphemism to explain away less ideal outcomes. Yet the phrase continues without clear specificity. The study is a review of some of the problems in planning the surgical care for the spinal patient. Spinal surgeons generally do not follow their patients after surgery long enough to fully comprehend the results and the impacts of their procedures, especially as viewed by the patient. We present an alternative approach that reduces the role of the spinal surgeon by encouraging more input from those who are likely to follow the patient who might not fare well. Experience in the treatment of surgical failures educates these practitioners to provide an evidence-based approach to surgical indications not as readily available to the spinal surgeon in many modern surgical practices.

show abstract

“…It is possible that transforaminal injections conducted under fluoroscopic guidance are more effective than interlaminar epidural approaches, but this has not been established definitively in controlled trials. Unfortunately, the literature fails to provide clarity regarding the optimal frequency, timing, and number of epidural steroid injections for the treatment of radicular neuropathic pain in the extremities [23,101]. …”

Section: Radiculopathy and Failed Back Surgery Syndromementioning

confidence: 99%

Interventional management of neuropathic pain: NeuPSIG recommendations

Dworkin

O’Connor

Kent

et al. 2013

Pain

376

288

View full text Add to dashboard Cite

Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central post-stroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: (1) epidural injections for herpes zoster; (2) steroid injections for radiculopathy; (3) SCS for FBSS; and (4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials; long-term studies; and head-to-head comparisons among different interventional and non-interventional treatments.

show abstract

The Basis for Recommending Repeating Epidural Steroid Injections for Radicular Low Back Pain: A Literature Review

Cited by 43 publications

References 30 publications

Epidural Injections for Spinal Pain

Epidural Injections for Spinal Pain

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

Interventional management of neuropathic pain: NeuPSIG recommendations

Contact Info

Product

Resources

About