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Randomized Controlled Trial
. 2014 Nov;121(5):1045-55.
doi: 10.1097/ALN.0000000000000409.

Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain: A Multicenter, Randomized, Comparative-Effectiveness Study

Affiliations
Randomized Controlled Trial

Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain: A Multicenter, Randomized, Comparative-Effectiveness Study

Steven P Cohen et al. Anesthesiology. .

Abstract

Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.

Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.

Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006).

Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

Comment in

  • The proper role for epidural injection of corticosteroids.
    Rathmell JP. Rathmell JP. Anesthesiology. 2014 Nov;121(5):919-21. doi: 10.1097/ALN.0000000000000439. Anesthesiology. 2014. PMID: 25335170 No abstract available.
  • Inappropriate trial of cervical epidural injections.
    Manchikanti L, Benyamin RM, Hirsch JA. Manchikanti L, et al. Anesthesiology. 2015 Jun;122(6):1441-2. doi: 10.1097/ALN.0000000000000651. Anesthesiology. 2015. PMID: 25988417 No abstract available.
  • In reply.
    Cohen SP, Hayek S, Pasquina PF, Vorobeychik Y. Cohen SP, et al. Anesthesiology. 2015 Jun;122(6):1443-4. doi: 10.1097/ALN.0000000000000652. Anesthesiology. 2015. PMID: 25988418 No abstract available.

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