Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials (original) (raw)
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Revue du rhumatisme (English ed.), 1999
Several randomized trials have suggested recently that epidural steroid injections may not be a valid treatment in common low back pain and sciatica. To clarify this issue, we conducted a critical appraisal of relevant randomized trials published up to 1997. Attention was directed to methodological quality, results, and clinical implications. A Medline search identified 13 trials published between 1966 and 1997. Trial methodology was evaluated using a 100-point grid based on four groups of items, namely study population, therapeutic intervention, evaluation method, and data presentation and analysis. Methodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group. Eight trials found no measurable benefits. Obstacles to meaningful comparisons across studies included differences in the patient populations, steroid used...
Our experience with epidural steroid injections in the management of low back pain and sciatica
The Internet Journal of Orthopedic Surgery, 2012
Background: Low back pain (LBP) and sciatica is a common clinical condition worldwide.The initial treatment of Low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a reliable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of ongoing study of the use of epidural steroid injection the management of low back pain cases coming to the orthopaedic department of Government Medical College Jammu. Methods: 150 Patients reporting with low back pain and sciatica not responding to other modes of conservative treatment were prospectively followed over a two year period. The caudal epidural steroid injections were performed, as many as three injections two week apart .The patients were assessed before and after the procedure clinically and the Level of pain, improvement in physical signs and ability to do activities of daily living were noted. Results:150 patients were observed for the duration of 2 years. Average duration of symptoms was for six months. After first epidural steroid injection 80% [120] of patients reported relief within first two weeks. Forty Four (44) patients required two injections and 12 patients required three injections. Twelve (12) patients reported no relief after first injection. The duration between two injections was two to three weeks. Average duration of pain relief was 17days. At the end of three months, good results were seen in 49%, fair in 32% and bad results in 18%. Overall 69% of patients were able to do activities of daily living. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. Conclusion: Epidural Steroid Injection is a simple, cost effective and minimally invasivemode of treatment of Low Back Pain and sciatica. It provides pain free period to enable the patient for physiotherapy which helps in early recovery.
Our experience with epidural steroid injections in management of low backpain and sciatica
2005
Background: Low back pain (LBP) and sciatica is a common clinical condition worldwide.The initial treatment of Low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a reliable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of ongoing study of the use of epidural steroid injection the management of low back pain cases coming to the orthopaedic department of Government Medical College Jammu. Methods: 150 Patients reporting with low back pain and sciatica not responding to other modes of conservative treatment were prospectively followed over a two year period. The caudal epidural steroid injections were performed, as many as three injections two week apart .The patients were assessed before and after the procedure clinically and the Level of pain, improvement in physical signs and ability to do activities of daily living were noted. Results:150 patients were observed for the duration of 2 years. Average duration of symptoms was for six months. After first epidural steroid injection 80% [120] of patients reported relief within first two weeks. Forty Four (44) patients required two injections and 12 patients required three injections. Twelve (12) patients reported no relief after first injection. The duration between two injections was two to three weeks. Average duration of pain relief was 17days. At the end of three months, good results were seen in 49%, fair in 32% and bad results in 18%. Overall 69% of patients were able to do activities of daily living. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. Conclusion: Epidural Steroid Injection is a simple, cost effective and minimally invasivemode of treatment of Low Back Pain and sciatica. It provides pain free period to enable the patient for physiotherapy which helps in early recovery.
Frontiers in Pain Research
Background: Epidural steroid injection (ESI) has proven benefits in controlling chronic low back pain and can be performed via the midline interlaminar (MIL) or transforaminal (TF) approach. A modified interlaminar approach, the parasagittal interlaminar (PIL), has surfaced as a more reliable, safe, and suitable approach to minimize complications related to MIL and TF.Objective: To conduct a systematic review and meta-analysis to assess and compare the effectiveness and safety of PIL with both MIL and TF approaches in adult patients with a history of chronic low back pain.Methods: A literature search was conducted using major electronic databases, such as PubMed, EMBASE, and Cochrane. Selected studies included patients with unilateral radicular symptoms, secondary to lumbar intervertebral disc hernias or degenerative lumbar disc disease, that, additionally, received ESIs via PIL or either MIL or TF under fluoroscopic guidance. Randomized and observational studies with pain relief sc...
Management of Low Back Pain by Administration of Epidural Steroid Injection
Innovative Publication, 2016
The likelihood of experiencing an episode of low back pain increases with age, and 85% of people will have at least one episode in their lifetime. Prevalence of low back pain is next only to headache. Total 50 patients (28 male and 22 female) who met the inclusion and exclusion criteria underwent epidural steroid injection. Patient pain scaling is done before performing the procedure, after 48 hours, after 2 weeks, after 3 months of the procedure. The proposed pain scale to be used is Numerical Rating Scale. Out of total 50 patients, after 48 hours it was found 30 patients had mild pain (NRS 1-3),18 patients moderate pain (NRS 4-6) and 2 patient continued to have severe pain (NRS 7-10). After 2 weeks it was found 24 patients to be mild pain, 24 patients with moderate pain and 2 patient with severe pain. After 3 months it was found 14 patients had mild pain, 32 patients had moderate pain and 4 patients had severe pain. The effect of epidural steroid injection decreases with time. The local effect of steroids has been shown to last at least 2 to 3 weeks at a therapeutic level. Epidural Steroid Injection is a safe, effective, & economical treatment modality for LBP. It reduces the period of hospitalization, analgesic intake & facilitates the institution of early rehabilitative programs.
Role of caudal epidural steroid injections in the management of chronic low backache
IP innovative publication pvt. ltd, 2019
Introduction: Back pain especially in lumbar region has increased to epidemic proportions in general population. It may have associated radiculopathy. Conservative treatment is mainstay treatment for all eviating pain and radiculopathy. A dependable alternative is epidural steroid injection given in multiple doses. Materials and Methods: 50 Patients were treated with caudal epidural steroid injection for chronic low backache of more than three months at our institute. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day to day life and work performance on the basis of visual analogue scale and oswestry disability index. Results: Patients were followed for one year. They were categorized into excellent, good, fair and poor on the basis of pain alleviation and capability to work. We reported excellent 13, good 15, fair 12 and 10 poor results. Three patients required surgery for disc prolapse. Only complication reported was pain at epidural injection region. Conclusion: Epidural steroids are slowly proving to be a reliable alternative for all eviating pain and radiculopathy for a short term. It provides significant symptom free time for patients to receive physiotherapy that is crucial for early and adequate rehabilitation.
Epidural steroids in the management of chronic spinal pain: a systematic review
Pain physician, 2007
Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain. To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions. A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used. Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies o...
Role of Caudal Epidural Injections in the Management of Chronic Low Back Pain
Pain Physician, 2002
Caudal epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain. Reports of the effectiveness of all types of epidural steroids have varied from 18% to 90%. Sicard, a radiologist, was the first to describe injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901, to treat patients suffering from severe, intractable sciatic pain or lumbago. This was followed by an explosion of reports and evolving interest in caudal epidural steroids with two additional reports in 1901 and numerous other reports over the years. The philosophy of epidural steroid injections is based on the premise that the corticosteroid delivered into the epidural space attains higher local concentrations over an inflamed nerve root and will be more effective than a steroid administered either orally or by in-tramuscular injection. The clinical effectiveness evaluations fill the literature with various types of reports including randomized clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regards to the clinical and cost-effectiveness of caudal epidural injections is encouraging. This review discusses various aspects of the role of caudal epidural injections in the management of chronic low back pain, including pathophysiology of low back pain, indications, clinical effectiveness and complications.