Epidural Steroid Injections for Low Back Pain and Sciatica

A systematic review 1 including 12 RCTs with a total of 534 subjects was abstracted in DARE. The control interventions or drugs included saline, midazolam and dextrose, bupivacaine, dry-needling, procaine, and lignocaine.

The trials showed inconsistent results of steroid injections: 6 studies reported positive results and 6 reported negative results. The positive and negative studies were more or less similar with regard to their methodological quality.

Another systematic review 2 including 11 studies with a total of 907 subjects was abstracted in DARE. The pooled OR for short time>75% pain relief was 2.61 (95% CI 1.80 to 3.77) in favour of epidural injections. The OR for complete relief was 2,79 (95% CI 1.92 to 4.06). The pooled OR for long-term >75% pain relief was 1.87 (95% CI 1.31 to 2.68). Four trials did not report adverse events. The other trials (431 patients) reported eleven dural taps (2.5%), 10 transient headaches (2.3%), transient increase in pain (1.9%) and one patient complained of irregular periods. No meaningful comparisons were made, however between active and control group.

A third systematic review 3 including 13 RCTs with a total of 722 subjects was abstracted in DARE. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group, whereas eight trials found no measurable benefit. In one study 91% of patients had returned to work after three months in the epidural steroid group versus 60% in the control group.

Comment: The quality of evidence is downgraded by inconsistency of results and possibility of reporting bias.

References

• Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995 Dec;63(3):279-88. [PubMed] [DARE]
• Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care 1995 Oct;23(5):564-9. [PubMed] [DARE]
• Rozenberg S, Dubourg G, Khalifa P, Paolozzi L, Maheu E, Ravaud P. Efficacy of epidural steroids in low back pain and sciatica. A critical appraisal by a French Task Force of randomized trials. Critical Analysis Group of the French Society for Rheumatology. Rev Rhum Engl Ed 1999 Feb;66(2):79-85. [PubMed] [DARE]