Epidural Corticosteroid Injections for Sciatica
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1097/BRS.0000000000003651 http://hdl.handle.net/11449/210050 |
Resumo: | Study Design. Systematic with meta-analysis Objectives. The aim of this study was to investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection in reducing leg pain and disability in patients with sciatica. Summary of Background Data. Conservative treatments, including pharmacological and nonpharmacological treatments, are typically the first treatment options for sciatica but the evidence to support their use is limited. The overall quality of evidence found by previous systematic reviews varies between moderate and high, which suggests that future trials may change the conclusions. New placebo-controlled randomized trials have been published recently which highlights the importance of an updated systematic review. Methods. The searches were performed without language restrictions in the following databases from 2012 to 25 September 2019: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PubMed, Embase, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and trial registers. We included placebo-controlled randomized trials investigating epidural corticosteroid injections in patients with sciatica. The primary outcomes were leg pain intensity and disability. The secondary outcomes were adverse events, overall pain, and back pain intensity. We grouped similar trials according to outcome measures and their respective follow-up time points. Short-term follow-up (>2 weeks but <= 3 months) was considered the primary follow-up time point due to the expected mechanism of action of epidural corticosteroid injection. Weighted mean differences (MDs) and risk ratios (RRs) with their respective 95% confidence intervals (CIs) were estimated. We assessed the overall quality of evidence using the GRADE approach and conducted the analyses using random effects. Results. We included 25 clinical trials (from 29 publications) providing data for a total of 2470 participants with sciatica, an increase of six trials when compared to the previous review. Epidural corticosteroid injections were probably more effective than placebo in reducing short-term leg pain (MD -4.93, 95% CI -8.77 to -1.09 on a 0-100 scale), short-term disability (MD -4.18, 95% CI: -6.04 to -2.17 on a 0-100 scale) and may be slightly more effective in reducing short-term overall pain (MD -9.35, 95% CI -14.05 to -4.65 on a 0-100 scale). There were mostly minor adverse events (i.e., without hospitalization) after epidural corticosteroid injections and placebo injections without difference between groups (RR 1.14, 95% CI: 0.91-1.42). The quality of evidence was at best moderate mostly due to problems with trial design and inconsistency. Conclusion. A review of 25 placebo-controlled trials provides moderate-quality evidence that epidural corticosteroid injections are effective, although the effects are small and short-term. There is uncertainty on safety due to very low-quality evidence. |
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Repositório Institucional da UNESP |
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Epidural Corticosteroid Injections for Sciaticaadrenal cortex hormonesepiduralinjectionsplacebossciaticaStudy Design. Systematic with meta-analysis Objectives. The aim of this study was to investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection in reducing leg pain and disability in patients with sciatica. Summary of Background Data. Conservative treatments, including pharmacological and nonpharmacological treatments, are typically the first treatment options for sciatica but the evidence to support their use is limited. The overall quality of evidence found by previous systematic reviews varies between moderate and high, which suggests that future trials may change the conclusions. New placebo-controlled randomized trials have been published recently which highlights the importance of an updated systematic review. Methods. The searches were performed without language restrictions in the following databases from 2012 to 25 September 2019: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PubMed, Embase, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and trial registers. We included placebo-controlled randomized trials investigating epidural corticosteroid injections in patients with sciatica. The primary outcomes were leg pain intensity and disability. The secondary outcomes were adverse events, overall pain, and back pain intensity. We grouped similar trials according to outcome measures and their respective follow-up time points. Short-term follow-up (>2 weeks but <= 3 months) was considered the primary follow-up time point due to the expected mechanism of action of epidural corticosteroid injection. Weighted mean differences (MDs) and risk ratios (RRs) with their respective 95% confidence intervals (CIs) were estimated. We assessed the overall quality of evidence using the GRADE approach and conducted the analyses using random effects. Results. We included 25 clinical trials (from 29 publications) providing data for a total of 2470 participants with sciatica, an increase of six trials when compared to the previous review. Epidural corticosteroid injections were probably more effective than placebo in reducing short-term leg pain (MD -4.93, 95% CI -8.77 to -1.09 on a 0-100 scale), short-term disability (MD -4.18, 95% CI: -6.04 to -2.17 on a 0-100 scale) and may be slightly more effective in reducing short-term overall pain (MD -9.35, 95% CI -14.05 to -4.65 on a 0-100 scale). There were mostly minor adverse events (i.e., without hospitalization) after epidural corticosteroid injections and placebo injections without difference between groups (RR 1.14, 95% CI: 0.91-1.42). The quality of evidence was at best moderate mostly due to problems with trial design and inconsistency. Conclusion. A review of 25 placebo-controlled trials provides moderate-quality evidence that epidural corticosteroid injections are effective, although the effects are small and short-term. There is uncertainty on safety due to very low-quality evidence.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Sao Paulo State Univ, Dept Physiotherapy, Presidente Prudente, BrazilUniv Sydney, Sydney Sch Publ Hlth, Sydney, NSW, AustraliaUniv Sydney, Sydney Med Sch, Inst Bone & Joint Res, Kolling Inst, Sydney, NSW, AustraliaMacquarie Univ, Fac Med & Hlth Sci, Discipline Physiotherapy, Sydney, NSW, AustraliaUniv Fed Vales Jequitinhonha & Mucuri UFVJM, Dept Physiotherapy, Diamantina, BrazilUniv Sydney, Fac Pharm, Sydney, NSW, AustraliaErasmus MC, Dept Gen Practice, Rotterdam, NetherlandsUniv Southern Denmark, Ctr Muscle & Joint Hlth, Odense, DenmarkUniv Sydney, Fac Hlth Sci, Discipline Physiotherapy, Sydney, NSW, AustraliaJohns Hopkins Univ, Blaustein Pain Treatment Ctr, Sch Med, Dept Anesthesiol, Baltimore, MD USAUniv Fed Minas Gerais UFMG, Dept Physiotherapy, Belo Horizonte, MG, BrazilSao Paulo State Univ, Dept Physiotherapy, Presidente Prudente, BrazilLippincott Williams & WilkinsUniversidade Estadual Paulista (Unesp)Univ SydneyMacquarie UnivUniversidade Federal de Viçosa (UFV)Erasmus MCUniv Southern DenmarkJohns Hopkins UnivUniversidade Federal de Minas Gerais (UFMG)Oliveira, Crystian B. [UNESP]Maher, Christopher G.Ferreira, Manuela L.Hancock, Mark J.Oliveira, Vinicius CunhaMcLachlan, Andrew J.Koes, Bart W.Ferreira, Paulo H.Cohen, Steven P.Pinto, Rafael Z.2021-06-25T12:38:11Z2021-06-25T12:38:11Z2020-11-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleE1405-E1415http://dx.doi.org/10.1097/BRS.0000000000003651Spine. Philadelphia: Lippincott Williams & Wilkins, v. 45, n. 21, p. E1405-E1415, 2020.0362-2436http://hdl.handle.net/11449/21005010.1097/BRS.0000000000003651WOS:000619513800007Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengSpineinfo:eu-repo/semantics/openAccess2024-06-18T18:44:27Zoai:repositorio.unesp.br:11449/210050Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T21:25:26.215279Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Epidural Corticosteroid Injections for Sciatica |
title |
Epidural Corticosteroid Injections for Sciatica |
spellingShingle |
Epidural Corticosteroid Injections for Sciatica Oliveira, Crystian B. [UNESP] adrenal cortex hormones epidural injections placebos sciatica |
title_short |
Epidural Corticosteroid Injections for Sciatica |
title_full |
Epidural Corticosteroid Injections for Sciatica |
title_fullStr |
Epidural Corticosteroid Injections for Sciatica |
title_full_unstemmed |
Epidural Corticosteroid Injections for Sciatica |
title_sort |
Epidural Corticosteroid Injections for Sciatica |
author |
Oliveira, Crystian B. [UNESP] |
author_facet |
Oliveira, Crystian B. [UNESP] Maher, Christopher G. Ferreira, Manuela L. Hancock, Mark J. Oliveira, Vinicius Cunha McLachlan, Andrew J. Koes, Bart W. Ferreira, Paulo H. Cohen, Steven P. Pinto, Rafael Z. |
author_role |
author |
author2 |
Maher, Christopher G. Ferreira, Manuela L. Hancock, Mark J. Oliveira, Vinicius Cunha McLachlan, Andrew J. Koes, Bart W. Ferreira, Paulo H. Cohen, Steven P. Pinto, Rafael Z. |
author2_role |
author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Univ Sydney Macquarie Univ Universidade Federal de Viçosa (UFV) Erasmus MC Univ Southern Denmark Johns Hopkins Univ Universidade Federal de Minas Gerais (UFMG) |
dc.contributor.author.fl_str_mv |
Oliveira, Crystian B. [UNESP] Maher, Christopher G. Ferreira, Manuela L. Hancock, Mark J. Oliveira, Vinicius Cunha McLachlan, Andrew J. Koes, Bart W. Ferreira, Paulo H. Cohen, Steven P. Pinto, Rafael Z. |
dc.subject.por.fl_str_mv |
adrenal cortex hormones epidural injections placebos sciatica |
topic |
adrenal cortex hormones epidural injections placebos sciatica |
description |
Study Design. Systematic with meta-analysis Objectives. The aim of this study was to investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection in reducing leg pain and disability in patients with sciatica. Summary of Background Data. Conservative treatments, including pharmacological and nonpharmacological treatments, are typically the first treatment options for sciatica but the evidence to support their use is limited. The overall quality of evidence found by previous systematic reviews varies between moderate and high, which suggests that future trials may change the conclusions. New placebo-controlled randomized trials have been published recently which highlights the importance of an updated systematic review. Methods. The searches were performed without language restrictions in the following databases from 2012 to 25 September 2019: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PubMed, Embase, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and trial registers. We included placebo-controlled randomized trials investigating epidural corticosteroid injections in patients with sciatica. The primary outcomes were leg pain intensity and disability. The secondary outcomes were adverse events, overall pain, and back pain intensity. We grouped similar trials according to outcome measures and their respective follow-up time points. Short-term follow-up (>2 weeks but <= 3 months) was considered the primary follow-up time point due to the expected mechanism of action of epidural corticosteroid injection. Weighted mean differences (MDs) and risk ratios (RRs) with their respective 95% confidence intervals (CIs) were estimated. We assessed the overall quality of evidence using the GRADE approach and conducted the analyses using random effects. Results. We included 25 clinical trials (from 29 publications) providing data for a total of 2470 participants with sciatica, an increase of six trials when compared to the previous review. Epidural corticosteroid injections were probably more effective than placebo in reducing short-term leg pain (MD -4.93, 95% CI -8.77 to -1.09 on a 0-100 scale), short-term disability (MD -4.18, 95% CI: -6.04 to -2.17 on a 0-100 scale) and may be slightly more effective in reducing short-term overall pain (MD -9.35, 95% CI -14.05 to -4.65 on a 0-100 scale). There were mostly minor adverse events (i.e., without hospitalization) after epidural corticosteroid injections and placebo injections without difference between groups (RR 1.14, 95% CI: 0.91-1.42). The quality of evidence was at best moderate mostly due to problems with trial design and inconsistency. Conclusion. A review of 25 placebo-controlled trials provides moderate-quality evidence that epidural corticosteroid injections are effective, although the effects are small and short-term. There is uncertainty on safety due to very low-quality evidence. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-11-01 2021-06-25T12:38:11Z 2021-06-25T12:38:11Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1097/BRS.0000000000003651 Spine. Philadelphia: Lippincott Williams & Wilkins, v. 45, n. 21, p. E1405-E1415, 2020. 0362-2436 http://hdl.handle.net/11449/210050 10.1097/BRS.0000000000003651 WOS:000619513800007 |
url |
http://dx.doi.org/10.1097/BRS.0000000000003651 http://hdl.handle.net/11449/210050 |
identifier_str_mv |
Spine. Philadelphia: Lippincott Williams & Wilkins, v. 45, n. 21, p. E1405-E1415, 2020. 0362-2436 10.1097/BRS.0000000000003651 WOS:000619513800007 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Spine |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
E1405-E1415 |
dc.publisher.none.fl_str_mv |
Lippincott Williams & Wilkins |
publisher.none.fl_str_mv |
Lippincott Williams & Wilkins |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1808129318217318400 |