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Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy., Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month., Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006)., Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

Objective Epidural steroid injections ( ESI) are the most commonly performed pain procedures. Despite numerous studies, controversy continues to surround their effectiveness. The purpose of this study is to determine whether a standard, clinical local anesthetic injection can predict outcomes for ESI. Study Design In this multicenter study, 103 patients received two ESI 2 weeks apart. Prior to their first injection, subjects rated the pain intensity of a standardized subcutaneous ( SQ) injection of lidocaine prior to the full dose. Numerical rating scale pain scores were correlated with leg and back pain relief, and functional improvement, through 3-month follow-up. Outcome Measures A composite successful outcome was predetermined to be a ≥2-point decrease in leg pain score, coupled with a positive global perceived effect. Results A small but significant relationship was found between SQ pain score and reduction in leg ( r = −0.21, 95% CI −0.38 to −0.04; P = 0.03) and back pain ( r = −0.22, 95% CI −0.36 to −0.07; P = 0.03). Subjects with a positive outcome at 1 month had a mean SQ pain score of 2.5 ( SD 1.9) vs 4.1 ( SD 2.7) in those with a negative outcome ( P = 0.04). Subjects with SQ pain scores <4/10 had lower leg and back pain scores than those with pain scores ≥4 at 1-month (mean 3.2, SD 2.6 vs 5.1, SD 2.7 for leg, P < 0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, P = 0.02) and 3-month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, P = 0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; P = 0.14) follow-up. Conclusions The results of this study found a weak positive correlation between SQ pain scores and treatment results. Further research should consider whether pain perception in conjunction with other variables might prove to be a reliable predictor for ESI and other procedural outcomes. [ABSTRACT FROM AUTHOR]

Background: Perineural inhibitors of tumor necrosis factor have recently generated intense interest as an alternative to epidural steroid injections for lumbosacral radiculopathy. Objective: To evaluate whether epidural steroids, etanercept, or saline better improves pain and function in adults with lumbosacral radiculopathy. Design: A multicenter, 3-group, randomized, placebo-controlled trial conducted from 2008 to 2011. Randomization was computergenerated and stratified by site. Pharmacists prepared the syringes. Patients, treating physicians, and nurses assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov registration number: NCT00733096) Setting: Military and civilian treatment centers. Patients: 84 adults with lumbosacral radiculopathy of less than 6 months' duration. Intervention: 2 epidural injections of steroids, etanercept, or saline, mixed with bupivacaine and separated by 2 weeks. Measurements: The primary outcome measure was leg pain 1 month after the second injection. All patients had 1-month follow-up visits; patients whose condition improved remained blinded for the 6-month study period. Results: The group that received epidural steroids had greater reductions in the primary outcome measure than those who received saline (mean difference, 1.26 [95% CI, 2.79 to 0.27]; P 0.11) or etanercept (mean difference, 1.01 [CI, 2.60 to 0.58]; P 0.21). For back pain, smaller differences favoring steroids compared with saline (mean difference, 0.52 [CI, 1.85 to 0.81]; P 0.44) and etanercept (mean difference, 0.92 [CI,2.28 to 0.44]; P 0.18) were observed. The largest differences were noted for functional capacity, in which etanercept fared worse than the other treatments: steroids vs. etanercept (mean difference, 16.16 [CI, 26.05 to 6.27]; P 0.002), steroids vs. saline (mean difference, 5.87 [CI, 15.59 to 3.85]; P 0.23), and etanercept vs. saline (mean difference, 10.29 [CI, 0.55 to 20.04]; P 0.04). More patients treated with epidural steroids (75%) reported 50% or greater leg pain relief and a positive global perceived effect at 1 month than those who received saline (50%) or etanercept (42%) (P 0.09). Limitation: Short-term follow-up, small sample size, and a possibly subtherapeutic dose of etanercept. Conclusion: Epidural steroid injections may provide modest shortterm pain relief for some adults with lumbosacral radiculopathy, but larger studies with longer follow-up are needed to confirm their benefits. Primary Funding Source: The John P. Murtha Neuroscience and Pain Institute, International Spinal Intervention Society, and Center for Rehabilitation Sciences Research. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine the use of magnetic resonance imaging (MRI) in patients referred for epidural steroid injections (ESI) and whether its use improves outcomes in patience with clinical symptoms of sciatica and affects decision making. One hundred thirty two patients were randomized in blocks of 26. It suggests that MRI will unlikely avert a procedure, diminish complications or improve outcomes and not ordering an MRI prior to lumbosacral ESI may save time and resources.

The article presents a study that investigated the efficacy of single epidural steroid injection or gabapentin on providing pain relief and functional improvement for sciatica. The study administered transforaminal epidural steroid injection on patients with unilateral pain and shows the similarity of the relief provided by both epidural steroid injection and gabapentin.