Abstract
BackgroundSteroids are often combined with local anesthetic (LA) and injected to reduce pain associated with various chronic non-cancer pain (CNCP) complaints. The biological rationale behind injection of a steroid solution is unclear, and it is uncertain whether the addition of steroids offers any additional benefits over injection of LA alone. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using steroids and LA vs. LA alone in the treatment of CNCP.MethodsAn experienced librarian will perform a comprehensive search of EMBASE, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases with search terms for clinical indications, LA, and steroid agents. We will review bibliographies of all relevant published reviews in the last 5 years for additional studies. Eligible trials will be published in English and randomly allocate patients with CNCP to treatment with steroid and LA injection therapy or injection with LA alone. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. We will prioritize intention to treat analysis and, when possible, pool outcomes across trials using random effects models. We will report our findings as risk differences, weighted mean differences, or standardized mean differences for individual outcomes. Further, to ensure interpretability of our results, we will present risk differences and measures of relative effect for pain reduction based on anchor-based minimally important clinical differences. We will conduct a priori defined subgroup analyses and use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the certainty of the evidence on an outcome-by-outcome basis.DiscussionOur review will evaluate both the effectiveness and the adverse events associated with steroid plus LA vs. LA alone for CNCP, evaluate the quality of the evidence using the GRADE approach, and prioritize patient-important outcomes guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with chronic non-cancer pain and identify key areas for future research.Trial registrationPROSPERO CRD42015020614Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0190-z) contains supplementary material, which is available to authorized users.
Highlights
Steroids are often combined with local anesthetic (LA) and injected to reduce pain associated with various chronic non-cancer pain (CNCP) complaints
We reviewed the systematic reviews published in English within the last 5 years, focusing on injection therapies using Corticosteroid injections (CSI) for CNCP conditions
Our primary objective is to perform a systematic review and meta-analysis to assess the effectiveness of steroid + LA injections compared to LA injections, for pain relief among CNCP patients
Summary
Steroids are often combined with local anesthetic (LA) and injected to reduce pain associated with various chronic non-cancer pain (CNCP) complaints. Burden of the problem Chronic non-cancer pain (CNCP), defined as pain persisting beyond the period of normal healing (typically ≥3 months), is commonly experienced by a large proportion of adult population. In the USA, according to 2008 estimates, approximately 100 million adults were affected by CNCP with associated treatment costs ranging from $560 to $635 billion (US). This is greater than annual treatment costs of heart disease, cancer, or diabetes [1]. Common peripheral (non-axial) CNCP conditions include pain in upper or lower limbs, knee and shoulder joints, headache, carpal tunnel syndrome, epicondylitis, fascitis and others
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