Epidural steroid injection therapy for low back pain

A meta-analysis

Hyun Jin Choi, Seokyung Hahn, Chi Heon Kim, Bo Hyoung Jang, Soyoung Park, Sang Moo Lee, Jung Yul Park, Chun Kee Chung, Byung Joo Park

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)244-253
Number of pages10
JournalInternational Journal of Technology Assessment in Health Care
Volume29
Issue number3
DOIs
Publication statusPublished - 2013 Jul 1

Fingerprint

Epidural Injections
Low Back Pain
Meta-Analysis
Steroids
Pain
Confidence Intervals
Randomized Controlled Trials
Placebos
Therapeutics
Social Adjustment
Injections
Selection Bias
Language
Databases

Keywords

  • Injection therapy
  • Low back pain
  • Meta-analysis
  • Radiculopathy
  • Systematic review

ASJC Scopus subject areas

  • Health Policy

Cite this

Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S. M., ... Park, B. J. (2013). Epidural steroid injection therapy for low back pain: A meta-analysis. International Journal of Technology Assessment in Health Care, 29(3), 244-253. https://doi.org/10.1017/S0266462313000342

Epidural steroid injection therapy for low back pain : A meta-analysis. / Choi, Hyun Jin; Hahn, Seokyung; Kim, Chi Heon; Jang, Bo Hyoung; Park, Soyoung; Lee, Sang Moo; Park, Jung Yul; Chung, Chun Kee; Park, Byung Joo.

In: International Journal of Technology Assessment in Health Care, Vol. 29, No. 3, 01.07.2013, p. 244-253.

Research output: Contribution to journalArticle

Choi, Hyun Jin ; Hahn, Seokyung ; Kim, Chi Heon ; Jang, Bo Hyoung ; Park, Soyoung ; Lee, Sang Moo ; Park, Jung Yul ; Chung, Chun Kee ; Park, Byung Joo. / Epidural steroid injection therapy for low back pain : A meta-analysis. In: International Journal of Technology Assessment in Health Care. 2013 ; Vol. 29, No. 3. pp. 244-253.
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