A Cochrane review [Abstract] 1 included 18 studies with a total of 1 179 subjects. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. 10 out of 18 trials were rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and study quality (inadequate or unclear allocation concealment and inadequate intention-to-treat adherence).
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