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Journal article
Epidural Injections for Spinal Pain A Systematic Review and Meta-analysis Evaluating the "Control" Injections in Randomized Controlled Trials
Anesthesiology (Philadelphia), v 119(4), pp 907-931
01 Oct 2013
PMID: 24195874
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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 [95% CI], 1.05 [0.88-1.25]; mean difference [95% CI], 0.22 [-0.50 to 0.94]).
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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Details
- Title
- Epidural Injections for Spinal Pain A Systematic Review and Meta-analysis Evaluating the "Control" Injections in Randomized Controlled Trials
- Creators
- Mark C. Bicket - Marymount UniversityAnita Gupta - Drexel UniversityCharlie H. Brown - Johns Hopkins UniversitySteven P. Cohen - Johns Hopkins University
- Publication Details
- Anesthesiology (Philadelphia), v 119(4), pp 907-931
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 25
- Grant note
- Centers for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Anesthesiology and Perioperative Medicine
- Web of Science ID
- WOS:000324475400031
- Scopus ID
- 2-s2.0-84888122509
- Other Identifier
- 991021876910604721
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- Web of Science research areas
- Anesthesiology