Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis.
Abstract | BACKGROUND:
Epidural injections have been used since 1901 in managing low back pain and sciatica. Spinal pain, disability, health, and economic impact continue to increase, despite numerous modalities of interventions available in managing chronic spinal pain. Thus far, systematic reviews performed to assess the efficacy of epidural injections in managing chronic spinal pain have yielded conflicting results. OBJECTIVE: To evaluate and update the clinical utility of the efficacy of epidural injections in managing chronic spinal pain. STUDY DESIGN: METHODS: In this systematic review, randomized trials with a placebo control or an active-control design were included. The outcome measures were pain relief and functional status improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB). Best evidence synthesis was conducted based on the qualitative level of evidence (Level I to V). Data sources included relevant literature identified through searches of PubMed for a period starting in 1966 through August 2015; Cochrane reviews; and manual searches of the bibliographies of known primary and review articles. RESULTS: LIMITATIONS: Even though this is a large systematic review with inclusion of a large number of randomized controlled trials, the paucity of high quality randomized trials literature continues to confound the evidence. CONCLUSION: This systematic review, with an assessment of the quality of manuscripts and outcome parameters, shows the efficacy of epidural injections in managing a multitude of chronic spinal conditions.
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Authors | Alan D Kaye, Laxmaiah Manchikanti, Salahadin Abdi, Sairam Atluri, Sanjay Bakshi, Ramsin Benyamin, Mark V Boswell, Ricardo Buenaventura, Kenneth D Candido, Harold J Cordner, Sukdeb Datta, Gulshan Doulatram, Christopher G Gharibo, Vahid Grami, Sanjeeva Gupta, Sachin Jha, Eugene D Kaplan, Yogesh Malla, Dharam P Mann, Devi E Nampiaparampil, Gabor Racz, Prithvi Raj, Maunak V Rana, Manohar Lal Sharma, Vijay Singh, Amol Soin, Peter S Staats, Ricardo Vallejo, Bradley W Wargo, Joshua A Hirsch |
Journal | Pain physician
(Pain Physician)
Vol. 18
Issue 6
Pg. E939-1004
(11 2015)
ISSN: 2150-1149 [Electronic] United States |
PMID | 26606031
(Publication Type: Journal Article, Review, Systematic Review)
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Chemical References |
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Topics |
- Analgesics
(administration & dosage)
- Anesthesia, Epidural
(methods)
- Anesthesia, Spinal
(methods)
- Chronic Pain
(diagnosis, drug therapy, epidemiology)
- Evidence-Based Medicine
(methods)
- Humans
- Injections, Epidural
- Intervertebral Disc Displacement
(diagnosis, drug therapy, epidemiology)
- Low Back Pain
(diagnosis, drug therapy, epidemiology)
- Pain Management
(methods)
- Radiculopathy
(diagnosis, drug therapy, epidemiology)
- Randomized Controlled Trials as Topic
(methods)
- Reproducibility of Results
- Spinal Stenosis
(diagnosis, drug therapy, epidemiology)
- Treatment Outcome
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