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EPIDURAL STEROID INJECTION THERAPY FOR LOW BACK PAIN: A META-ANALYSIS

Published online by Cambridge University Press:  17 June 2013

Hyun Jin Choi ,
Seokyung Hahn ,
Chi Heon Kim ,
Bo Hyoung Jang ,
Soyoung Park ,
Sang Moo Lee ,
Jung-Yul Park ,
Chun Kee Chung  and
Byung-Joo Park
Hyun Jin Choi
Affiliation:
Department of Preventive Medicine, Seoul National University College of Medicine
Seokyung Hahn
Affiliation:
Department of Medicine, Seoul National University College of Medicine; Medical Research Collaborating Center, Seoul National University Hospital
Chi Heon Kim
Affiliation:
Department of Neurosurgery, Seoul National University College of Medicine
Bo Hyoung Jang
Affiliation:
National Evidence-based Healthcare Collaborating Agency
Soyoung Park
Affiliation:
Department of Preventive Medicine, Seoul National University College of Medicine
Sang Moo Lee
Affiliation:
National Evidence-based Healthcare Collaborating Agency
Jung-Yul Park
Affiliation:
Department of Neurosurgery, Korea University College of Medicine
Chun Kee Chung
Affiliation:
Department of Neurosurgery, Seoul National University College of Medicine
Byung-Joo Park
Affiliation:
Department of Preventive Medicine, Seoul National University College of Medicine; Medical Research Collaborating Center, Seoul National University Hospital
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Abstract

Objectives: The aim of this study was to systematically assess the long-term (≥ 6 months) benefits of epidural steroid injection therapies for patients with low back pain.

Methods: We identified randomized controlled trials by database searches up to October 2011 and by additional hand searches without language restrictions. Randomized controlled trials on the effects of epidurals for low back pain with follow-up for at least 6 months were included. Outcomes considered were pain relief, functional improvement in 6 to 12 months after epidural steroid injection treatment and the number of patients who underwent subsequent surgery. Meta-analysis was performed using a random-effects model.

Results: Twenty-nine articles were selected. The meta-analysis suggested that a significant treatment effect on pain was noted at 6 months of follow-up (weighted mean difference [WMD], −0.41; 95 percent confidence interval [CI], −0.66 to −0.16), but was no longer statistically significant after adjusting for the baseline pain score (WMD, −0.19; 95 percent CI, −0.61 to 0.24). Epidural steroid injection did not improve back-specific disability more than a placebo or other procedure. Epidural steroid injection did not significantly decrease the number of patients who underwent subsequent surgery compared with a placebo or other treatments (relative risk, 1.02; 95 percent CI, 0.83 to 1.24).

Conclusions: A long-term benefit of epidural steroid injections for low back pain was not suggested at 6 months or longer. Introduction of selection bias in the majority of injection studies seems apparent. Baseline adjustment is essential when we evaluate pain as a main outcome of injection therapy.

Keywords

Low back painInjection therapyRadiculopathySystematic reviewMeta-analysis
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 3 , July 2013 , pp. 244 - 253
Copyright
Copyright © Cambridge University Press 2013 

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