HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study.

AbstractOBJECTIVE:
To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.
DESIGN:
A multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes.
SETTINGS:
Eight military, Veterans Administration, and civilian hospitals.
PARTICIPANTS:
145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain.
INTERVENTIONS:
Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin.
MAIN OUTCOME MEASURES:
Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥ 2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit.
RESULTS:
There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline -2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and -1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval -0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline -2.0 (SD 2.6) versus 3.7 (SD 2.8) and -1.6 (SD 2.7), respectively; adjusted difference 0.3, -0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (-3.0, SD 2.8) than those treated with gabapentin (-2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three months, there were no significant differences between treatments.
CONCLUSIONS:
Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.Trial registration ClinicalTrials.gov Identifier: NCT01495923.
AuthorsSteven P Cohen, Steven Hanling, Mark C Bicket, Ronald L White, Elias Veizi, Connie Kurihara, Zirong Zhao, Salim Hayek, Kevin B Guthmiller, Scott R Griffith, Vitaly Gordin, Mirinda Anderson White, Yakov Vorobeychik, Paul F Pasquina
JournalBMJ (Clinical research ed.) (BMJ) Vol. 350 Pg. h1748 (Apr 16 2015) ISSN: 1756-1833 [Electronic] England
PMID25883095 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Copyright© Cohen et al 2015.
Chemical References
  • Amines
  • Analgesics
  • Anti-Inflammatory Agents
  • Cyclohexanecarboxylic Acids
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Methylprednisolone
Topics
  • Adult
  • Amines (therapeutic use)
  • Analgesics (therapeutic use)
  • Analysis of Variance
  • Anti-Inflammatory Agents (administration & dosage)
  • Cyclohexanecarboxylic Acids (therapeutic use)
  • Double-Blind Method
  • Female
  • Gabapentin
  • Humans
  • Injections, Epidural
  • Low Back Pain (drug therapy)
  • Male
  • Methylprednisolone (administration & dosage)
  • Middle Aged
  • Pain Measurement
  • Radiculopathy (drug therapy)
  • gamma-Aminobutyric Acid (therapeutic use)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: