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Anesthesiology. 2013 Oct;119(4):907-31. doi: 10.1097/ALN.0b013e31829c2ddd.

Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the "control" injections in randomized controlled trials.

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1
* Resident, ‡ Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. † Associate Professor and Medical Director, University Pain Institute, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. § Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, and Professor, Walter Reed National Military Medical Center, Bethesda, Maryland.

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.

Comment in

PMID:
24195874
DOI:
10.1097/ALN.0b013e31829c2ddd
[Indexed for MEDLINE]
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