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Am Fam Physician. 2013;88(2):137

Clinical Question

Are epidural corticosteroid injections effective in decreasing pain and improving function in patients with sciatica?

Bottom Line

Epidural corticosteroid treatment produces a small and not clinically relevant decrease in leg pain and disability in the short term in patients with sciatica; any difference is gone after one year. (Level of Evidence = 1b)

Synopsis

These researchers searched six databases, including Cochrane CENTRAL, and identified 23 randomized controlled studies comparing epidural corticosteroid with placebo. Two reviewers independently screened the studies, extracted the data, and graded the evidence. The study quality was generally high, although most studies did not conceal allocation or use intention-to-treat analysis, which could have biased the results in favor of treatment. There was no evidence of publication bias, and heterogeneity was low to absent. Epidural corticosteroid treatment resulted in a small difference for leg pain (6.2 on a scale of 0 to 100) and disability (3.1) and no difference in back pain scores. Results did not differ by injection approach. There was no difference among treatments after one year.

Reference

PintoRZMaherCGFerreiraMLet alEpidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med.2012; 157( 12): 865– 877.

Study design: Randomized controlled trial (double-blinded)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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