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Epidural steroids for sciatica minimally effective in the short term

Clinical Question:
Are epidural corticosteroid injections effective in decreasing pain and improving function in patients with sciatica?

Bottom Line:
Epidural corticosteroid treatment produces a small and not clinically relevant decrease in leg pain and disability in the short term in patients with sciatica; any difference is gone after 1 year. (LOE = 1b)

Reference:
Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica. A systematic review and meta-analysis. Ann Intern Med 2012;157(12):865-877.  [PMID:23362516]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Self-funded or unfunded

Setting:
Various (meta-analysis)

Synopsis:
These researchers searched 6 databases, including Cochrane CENTRAL, and identified 23 randomized controlled studies comparing epidural corticosteroid with placebo. Two reviewers independently screened the studies, extracted the data, and graded the evidence. The study quality was generally high, though most studies did not conceal allocation or use intention-to-treat analysis, which could have biased the results in favor of treatment. There was no evidence of publication bias and heterogeneity was low to absent. Epidural steroid treatment resulted in a small difference for leg pain (6.2 on a scale of 0 to 100) and disability (3.1) and no difference in back pain scores. Results did not differ by injection approach. There was no difference among treatments after 1 year.

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