PAIN+ CPN

In people with radicular low back pain or spinal stenosis, epidural corticosteroid injections do not improve pain or function

This Evidence Summary is based on the following systematic review:

Chou R, Hashimoto R, Friedly J, et al. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Sep 1;163(5):373-81. doi: 10.7326/M15-0934. PubMed

Review questions

In people with radicular low back pain or spinal stenosis, do epidural corticosteroid injections improve pain and function?

Background

Radicular low back pain results from herniated discs or irritation of the nerves that supply the legs. The pain may be felt as lower back pain, sharp shooting pain in the legs, or burning. Symptoms may include numbness and difficulty using the affected limb(s).

Spinal stenosis results from compression in the spinal nerve roots of the lower back due to narrowing of the spinal canal. The pain may be felt as tingling, numbness, or weakness of the buttocks and legs.

Epidural corticosteroid injections are given by a needle inserted through the back into the space around the spinal cord in the affected area.

How the review was done

The researchers did a systematic review based on studies available up to May 2015.

They found 39 randomized controlled trials.

Key features of the trials were:

  • people had radicular low back pain or spinal stenosis;
  • treatment was epidural corticosteroid injections;
  • treatment was compared with controls, which included placebo, epidural saline, injections without corticosteroids, or no injection; and
  • outcomes were measured 1 week to 3 years after treatment.

What the researchers found

The quality of evidence varied. Findings that are based on moderate-strength evidence are reported here (low-strength evidence is not reported here).

People with radicular low back pain

Compared with control, epidural corticosteroid injections:

  • improved pain immediately after treatment, but the difference was small;
  • did not improve pain more than 1 year after treatment;
  • did not improve function; and
  • did not reduce long-term risk of surgery.

People with spinal stenosis

Epidural corticosteroid injections did not improve function more than control at 2 weeks to 3 months after treatment.

Conclusions

In people with radicular low back pain or spinal stenosis, epidural corticosteroid injections do not improve pain or function.

Effects of epidural corticosteroid injections in people with radicular low back pain or spinal stenosis*

Condition

Outcomes

Assessment periods

Number of trials (people)

Effects of epidural corticosteroid injections compared with control†

Radicular low back pain

Pain

Immediate (5 days to 2 weeks after treatment)

6 (701)

Small improvement that may not be important to patients: 7-points on a 100-point scale (but could be as few as 4 points or as many as 11 points)



More than 1 year after treatment

7 (887)

No difference


Successful pain outcome

More than 1 year after treatment

4 (504)

No difference


Function

2 weeks to 3 months after treatment

13 (1529)

No difference


Risk of surgery

More than 1 year after treatment

14 (1208)

No difference


Successful composite outcome

2 weeks to 3 months after treatment

9 (604)

No difference

Spinal stenosis

Function

2 weeks to 3 months after treatment

5 (615)

No difference

*Includes evidence of moderate strength (evidence of low strength is not shown here).

†Controls were placebo, epidural saline, injections without corticosteroids, or no injection.

This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.

Published: Friday, July 28, 2017