Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Research article

Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice

Authors: Antje Spijker-Huiges, Jan C Winters, Marten van Wijhe, Klaas Groenier

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Login to get access

Abstract

Background

Lumbosacral radicular syndrome (LRS) is a self-limiting, benign, painful and impairing condition caused by lumbar disc herniation and inflammatory processes around the nerve root. Segmental epidural steroid injections (SESIs) are helpful to reduce radicular pain on a short-term basis. It is unknown whether SESIs are an effective addition to usual pain treatment of LRS in general practice. In our study, we assessed the effectiveness of SESIs on pain and disability as an addition to usual care for acute LRS in general practice.

Methods

A pragmatic, single-blinded, randomized controlled trial in Dutch general practice was conducted. Circumstances of daily practice were closely followed. Care as usual (CAU) was compared to care as usual combined with an additional SESI in 63 patients in the acute phase of LRS. To detect a minimal clinically important difference of 1.2 points on a numerical rating scale for back pain and a common within-group standard deviation of 1.7 with a two-tailed alpha of 0.05 and a power of 0.80, we needed 33 subjects in each group. Statistical analysis was carried out using mixed models.

Results

A small significant effect in favour of the intervention, corrected for age, sex and baseline values, was found for back pain, impairment and Roland-Morris disability score. The differences, though statistically significant, were too small to be considered clinically relevant. Patients from the intervention group were significantly more satisfied with the received treatment than patients from the control group.

Conclusion

We found a small, statistically significant, but not clinically relevant positive effect of SESIs on back pain, impairment and disability in acute LRS. We do not recommend implementing SESIs as an additional regular treatment option in general practice.
Appendix
Available only for authorised users
Literature
1.
Mens JMA, Chavannes AW, Koes BW, Lubbers WJ, Ostelo RWJG: [NHG-guideline Lumbosacral Syndrome] NHG-standaard Lumbosacraal Radiculair Syndroom. Huisarts en Wetenschap. 2005, 48: 171-178. 10.1007/BF03084178.CrossRef
2.
Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW: Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J. 2007, 16: 881-899. 10.1007/s00586-007-0367-1.CrossRefPubMedPubMedCentral
3.
Vroomen PC, de Krom MC, Slofstra PD, Knottnerus JA: Conservative treatment of sciatica: a systematic review. J Spinal Disord. 2000, 13: 463-469. 10.1097/00002517-200012000-00001.CrossRefPubMed
4.
Saal JS: The role of inflammation in lumbar pain. Spine (Phila Pa 1976). 1995, 20: 1821-1827. 10.1097/00007632-199508150-00013.CrossRef
5.
DePalma MJ, Bhargava A, Slipman CW: A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehabil. 2005, 86: 1477-1483. 10.1016/j.apmr.2005.01.006.CrossRefPubMed
6.
McCarron RF, Wimpee MW, Hudkins PG, Laros GS: The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine. 1987, 12: 760-764. 10.1097/00007632-198710000-00009.CrossRefPubMed
7.
Nygaard OP, Mellgren SI, Osterud B: The inflammatory properties of contained and noncontained lumbar disc herniation. Spine. 1997, 22: 2484-2488. 10.1097/00007632-199711010-00004.CrossRefPubMed
8.
Arden NK, Price C, Reading I, Stubbing J, Hazelgrove J, Dunne C, Michel M, Rogers P, Cooper C, WEST Study Group: A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology. 2005, 44: 1399-1406. 10.1093/rheumatology/kei028.CrossRefPubMed
9.
Koes BW, Scholten RJ, Mens JM, Bouter LM: Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain. 1995, 12: 279-288.CrossRef
10.
Nelemans PJ, de Bie RA, de Vet HC, Sturmans F: Injection therapy for subacute and chronic benign low back pain. Cochrane Database Syst Rev. 2000, 2: 1469-1493.
11.
Price C, Arden N, Coglan L, Rogers P: Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technol Assess. 2005, 9: 1-58.CrossRefPubMed
12.
Hopayian K, Mugford M: Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?. Br J Gen Pract. 1999, 49: 57-61.PubMedPubMedCentral
13.
Karppinen J, Malmivaara A, Kurunlahti M, Kyllonen E, Pienimaki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H: Periradicular infiltration for sciatica: a randomized controlled trial. Spine. 2001, 26: 1059-1067. 10.1097/00007632-200105010-00015.CrossRefPubMed
14.
Kolsi I, Delecrin J, Berthelot JM, Thomas L, Prost A, Maugars Y: Efficacy of nerve root versus interspinous injections of glucocorticoids in the treatment of disk-related sciatica. A pilot, prospective, randomized, double-blind study. Joint Bone Spine. 2000, 67: 113-118.PubMed
15.
Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K: The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000, 82: 1589-1593.PubMed
16.
Vad VB, Bhat AL, Lutz GE, Cammisa F: Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002, 27: 11-16. 10.1097/00007632-200201010-00005.CrossRefPubMed
17.
Buchner M, Zeifang F, Brocai DR, Schiltenwolf M: Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop. 2000, 375: 149-156.CrossRefPubMed
18.
Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St Pierre A, Truchon R, Parent F, Levesque J, Bergeron V, Montminy P, Blanchette C: Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997, 336: 1634-1640. 10.1056/NEJM199706053362303.CrossRefPubMed
19.
20.
Valat JP, Genevay S, Marty M, Rozenberg S, Koes B: Sciatica. Best Pract Res Clin Rheumatol. 2010, 24: 241-252. 10.1016/j.berh.2009.11.005.CrossRefPubMed
21.
Buenaventura RM, Datta S, Abdi S, Smith HS: Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009, 12: 233-251.PubMed
22.
Lafuma A, Bouvenot G, Cohen C, Eschwege E, Fagnani F, Vignon E: A pragmatic cost-effectiveness study of routine epidural corticosteroid injections for lumbosciatic syndrome requiring inhospital management. Rev Rhum Engl Ed. 1997, 64: 549-555.PubMed
23.
Luijsterburg PA, Verhagen AP, Braak S, Oemraw A, Avezaat CJ, Koes BW: General practitioners’ management of lumbosacral radicular syndrome compared with a clinical guideline. Eur J Gen Pract. 2005, 11: 113-118. 10.3109/13814780509178250.CrossRefPubMed
24.
Lauridsen HH, Hartvigsen J, Korsholm L, Grunnet-Nilsson N, Manniche C: Choice of external criteria in back pain research: Does it matter? Recommendations based on analysis of responsiveness. Pain. 2007, 131: 112-120. 10.1016/j.pain.2006.12.023.CrossRefPubMed
25.
Roland M, Fairbank J: The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000, 25: 3115-3124. 10.1097/00007632-200012150-00006.CrossRefPubMed
26.
Peul WC, Van Houwelingen HC, Van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW: Early surgery or a wait-and-see policy in lumbosacral radicular syndrome: a randomized study. Ned Tijdschr Geneeskd. 2007, 151: 2512-2523.PubMed
27.
Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW: Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007, 356: 2245-2256. 10.1056/NEJMoa064039.CrossRefPubMed
28.
Jordan K, Dunn KM, Lewis M, Croft P: A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. J Clin Epidemiol. 2006, 59: 45-52. 10.1016/j.jclinepi.2005.03.018.CrossRefPubMed
29.
Farrar JT, Pritchett YL, Robinson M, Prakash A, Chappell A: The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders. J Pain. 2010, 11: 109-118. 10.1016/j.jpain.2009.06.007.CrossRefPubMed
30.
Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001, 94: 149-158. 10.1016/S0304-3959(01)00349-9.CrossRefPubMed
31.
Kelly AM: The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001, 18: 205-207. 10.1136/emj.18.3.205.CrossRefPubMedPubMedCentral
32.
Mohan H, Ryan J, Whelan B, Wakai A: The end of the line? The Visual Analogue Scale and Verbal Numerical Rating Scale as pain assessment tools in the emergency department. Emerg Med J. 2010, 27: 372-375. 10.1136/emj.2007.048611.CrossRefPubMed
33.
Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain. 1997, 72: 95-97. 10.1016/S0304-3959(97)00005-5.CrossRefPubMed
34.
Peters SA, Bots ML, Ruijter HM, Palmer MK, Grobbee DE, Crouse JR, O'Leary DH, Evans GW, Raichlen JS, Moons KG, Koffijberg H: Multiple imputation of missing repeated outcome measurements did not add to linear mixed-effects models. J Clin Epidemiol. 2012, 65 (6): 686-695. 10.1016/j.jclinepi.2011.11.012.CrossRefPubMed
35.
Posner JB, Howieson J, Cvitkovic E: “Disappearing” spinal cord compression: oncolytic effect of glucocorticoids (and other chemotherapeutic agents) on epidural metastases. Ann Neurol. 1977, 2: 409-413. 10.1002/ana.410020511.CrossRefPubMed
Metadata
Title
Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice
Authors
Antje Spijker-Huiges
Jan C Winters
Marten van Wijhe
Klaas Groenier
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-341

Other articles of this Issue 1/2014

BMC Musculoskeletal Disorders 1/2014 Go to the issue

Research article

Effects of pamidronate disodium on the loss of osteoarthritic subchondral bone and the expression of cartilaginous and subchondral osteoprotegerin and RANKL in rabbits

Research article

Does arthroscopic sub-acromial decompression really work for sub-acromial impingement syndrome: a cohort study

Research article

Lateral insertion is a good prognostic factor after in situ fixation in slipped capital femoral epiphysis

Research article

Radiographic signs for detection of femoroacetabular impingement and hip dysplasia should be carefully used in patients with osteoarthritis of the hip

Study protocol

Design characteristics of the CORRONA CERTAIN study: a comparative effectiveness study of biologic agents for rheumatoid arthritis patients

Study protocol

Evaluation of efficacy of a new hybrid fusion device: a randomized, two-centre controlled trial