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

Antje Spijker-Huiges,Marten Van Wijhe,Jan C Winters,Klaas Groenier

doi:10.1186/1471-2474-15-341

Antje Spijker-Huiges, Marten Van Wijhe + Show 2 more

Open Access

https://doi.org/10.1186/1471-2474-15-341

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Abstract

BackgroundLumbosacral 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.MethodsA 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.ResultsA 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.ConclusionWe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-341) contains supplementary material, which is available to authorized users.

Highlights

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
Of one subject the follow-up was incomplete. She died during the study period due to Burkitt lymphoma, which initially caused radicular pain
Outcomes of this study suggested that adding Segmental epidural steroid injection (SESI) as a first-line treatment to rest and a nonsteroidal antiinflammatory drug for LRS resulted in additional costs and no gain in efficacy

Summary

Introduction

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. LRS is most commonly caused by protrusion of a lumbar intervertebral disc, which results in an inflammatory response around the nerve root [1,4]. This inflammatory process is the cause of the radicular pain, rather than mechanical compression [5,6,7,8]. Local anti-inflammatory drugs may lessen inflammation and pain, making it easier for patients to profit from the favourable prognosis

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