Cochrane for Clinicians

Putting Evidence into Practice

Epidural Corticosteroid Injections for Lumbosacral Radicular Pain

 

Am Fam Physician. 2021 Apr 1;103(7):405-406.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are epidural corticosteroid injections safe and more effective than other injections for the treatment of lumbosacral radicular pain?

Evidence-Based Answer

Epidural corticosteroid injections for the treatment of lumbosacral radicular pain may offer modest short-term (two weeks to three months) benefit compared with placebo injection for radicular leg pain (mean difference [MD] = −4.93; 95% CI, −8.77 to −1.09 on a scale of 0 to 100) and disability (MD = −4.18; 95% CI, −6.04 to −2.17 on a scale of 0 to 100). After three months, there does not appear to be any added benefit with the use of corticosteroid.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.) Minor adverse effects from corticosteroid injection are no more common than with placebo injection, based on very low-quality data.

Practice Pointers

Lumbosacral radicular pain is radiating pain that results from injury or irritation of nerve roots in the lower back. Lumbosacral radicular pain is most often caused by disc herniation with nerve root compression. Most patients with this condition improve over time, but the degree of pain and disability is variable and leads some patients to seek invasive intervention. Epidural corticosteroid injections can be administered in an outpatient setting. This review sought to determine if epidural corticosteroid injection is more effective than placebo injection for the treatment of lumbosacral pain and disability.

This Cochrane review included 25 randomized trials and 2,470 patients1; it updates a previous 2012 review. Six additional studies were added to this review, but the overall conclusions were largely unchanged from 2012. The review considered only trials that included a placebo injection as the control arm of the study. Results of individual studies were grouped by timing of response measured and thus characterized as immediate (less than two weeks), short term (two weeks to three months), in

Author disclosure: No relevant financial affiliations.

References

show all references

1. Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;(4):CD013577....

2. U.S. Food and Drug Administration. Drug Safety Communications. FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. April 23, 2014. Accessed July 21, 2020. https://www.fda.gov/media/88483/download

3. Donohue NK, Tarima SS, Durand MJ, et al. Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study. Korean J Pain. 2020;33(2):192–198.

4. Smith CC, McCormick ZL, Mattie R, et al. The effectiveness of lumbar transforaminal injection of steroid for the treatment of radicular pain: a comprehensive review of the published data. Pain Med. 2020;21(3):472–487.

5. Manchikanti L, Knezevic NN, Parr A, et al. Does epidural bupivacaine with or without steroids provide long-term relief? A systematic review and meta-analysis. Curr Pain Headache Rep. 2020;24(6):26.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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