Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Symptoms
| Autor: | Thomas M de Bruijn, Raymond W. J. G. Ostelo, Johan Haumann, Harald S. Miedema, Ingrid B de Groot |
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| Přispěvatelé: | Epidemiology and Data Science, AMS - Musculoskeletal Health, APH - Quality of Care, APH - Societal Participation & Health |
| Rok vydání: | 2021 |
| Předmět: |
Radicular Syndrome
medicine.medical_specialty epidural steroid injection medicine.medical_treatment MEDLINE lumbosacral radicular syndrome artikel tijdschrift law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Quality of life 030202 anesthesiology law Internal medicine medicine Humans Clinical significance Radiculopathy sciatica Sciatica De Bruijn sequence Epidural steroid Epidural steroid injection business.industry steroid Lumbosacral Region Dermatology Anesthesiology and Pain Medicine Meta-analysis Steroids Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | The Clinical Journal of Pain, 37 (2021)(7 (July)), 524-537. Wolters Kluwer de Bruijn, T M, de Groot, I B, Miedema, H S, Haumann, J & Ostelo, R W J G 2021, ' Clinical relevance of epidural steroid injections on lumbosacral radicular syndrome-related synptoms systematic review and meta-analysis ', Clinical Journal of Pain, vol. 37, no. 7, pp. 524-537 . https://doi.org/10.1097/AJP.0000000000000943 Clinical Journal of Pain, 37(7), 524-537. Lippincott Williams and Wilkins |
| ISSN: | 1536-5409 0749-8047 |
| DOI: | 10.1097/ajp.0000000000000997 |
| Popis: | Objectives: Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. Materials and Methods: Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence. Results: Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low. Discussion: On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue. |
| Databáze: | OpenAIRE |
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