Epidural steroid injection therapy for low back pain: a meta-analysis 
International Journal of Technology Assessment in Health Care, 07/24/2013  Evidence Based Medicine  Review Article  Clinical Article

Choi HJ et al. – The aim of this study was to systematically assess the long–term (≥ 6 months) benefits of epidural steroid injection therapies for patients with low back pain. A long–term benefit of epidural steroid injections for low back pain was not suggested at 6 months or longer. Introduction of selection bias in the majority of injection studies seems apparent. Baseline adjustment is essential when the authors evaluate pain as a main outcome of injection therapy.

Methods

• The authors identified randomized controlled trials by database searches up to October 2011 and by additional hand searches without language restrictions.
• Randomized controlled trials on the effects of epidurals for low back pain with follow–up for at least 6 months were included.
• Outcomes considered were pain relief, functional improvement in 6 to 12 months after epidural steroid injectiontreatment and the number of patients who underwent subsequent surgery.
• Meta–analysis was performed using a random–effects model.

Results

• Twenty–nine articles were selected.
• The meta–analysis suggested that a significant treatment effect on pain was noted at 6 months of follow–up (weighted mean difference [WMD], –0.41; 95 percent confidence interval [CI], –0.66 to –0.16), but was no longer statistically significant after adjusting for the baseline pain score (WMD, –0.19; 95 percent CI, –0.61 to 0.24).
• Epidural steroid injection did not improve back–specific disability more than a placebo or other procedure.
• Epidural steroid injection did not significantly decrease the number of patients who underwent subsequent surgery compared with a placebo or other treatments (relative risk, 1.02; 95 percent CI, 0.83 to 1.24).

International Journal of Technology Assessment in Health Care, 07/24/2013