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 journalArticlepeer-review

    13 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

    Keywords

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

    ASJC Scopus subject areas

    • Health Policy

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