Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis
Authors: Roger Chou, Robin Hashimoto, Janna Friedly
Journal: Annals of Internal Medicine (2016)

Letters3 May 2016Epidural Corticosteroid Injections for Radiculopathy and Spinal StenosisRoger Chou, MD, Robin Hashimoto, PhD, and Janna Friedly, MDRoger Chou, MDFrom Oregon Health & Science University, Portland, Oregon; Spectrum Research, Tacoma, Washington; and University of Washington, Seattle, Washington.Search for more papers by this author, Robin Hashimoto, PhDFrom Oregon Health & Science University, Portland, Oregon; Spectrum Research, Tacoma, Washington; and University of Washington, Seattle, Washington.Search for more papers by this author, and Janna Friedly, MDFrom Oregon Health & Science University, Portland, Oregon; Spectrum Research, Tacoma, Washington; and University of Washington, Seattle, Washington.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0563 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Manchikanti and colleagues suggest that local anesthetic epidural injections have long-term therapeutic effects and should not be considered a placebo. Our definition of placebo was based on the assumption that the therapeutic effects of epidural injection are primarily related to the corticosteroid. This is consistent with clinical practice and the rationale for epidural injections, which are predicated on corticosteroids' anti-inflammatory properties. Further, our findings were similar when analyses were stratified according to the type of placebo comparator used (local anesthetic epidural, saline epidural, soft tissue injection, or no injection), arguing against a specific local anesthetic therapeutic effect. ...References1. Ghahreman A, Ferch R, Bogduk N.. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med. 2010;11:1149-68. [PMID: 20704666] doi:10.1111/j.1526-4637.2010.00908.x CrossrefMedlineGoogle Scholar2. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5:e23139. [PMID: 25789241] doi:10.5812/aapm.23139 CrossrefMedlineGoogle Scholar3. MacVicar J, King W, Landers MH, Bogduk N. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med. 2013;14:14-28. [PMID: 23110347] doi:10.1111/j.1526-4637.2012.01508.x CrossrefMedlineGoogle Scholar4. Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 10(14)-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Oregon Health & Science University, Portland, Oregon; Spectrum Research, Tacoma, Washington; and University of Washington, Seattle, Washington.Grant Support: By the Agency for Healthcare Research and Quality, for conducting the review that is the subject of this response.Disclosures: Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0934. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Roger Chou , Robin Hashimoto , Janna Friedly , Rongwei Fu , Christina Bougatsos , Tracy Dana , Sean D. Sullivan , and Jeffrey Jarvik Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Laxmaiah Manchikanti , Alan David Kaye , and Joshua A. Hirsch Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Timothy P. Maus , Belinda S. Duszynski , and Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Irbaz Bin Riaz and Robert G. Badgett Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Denis F. Darko Metrics Cited byOutcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic reviewManagement of Chronic Low Back Pain: Review of Fluoroscopy-Guided Epidural Steroid InjectionEpidural steroid injection versus conservative treatment for patients with lumbosacral radicular painEpidural steroids following percutaneous endoscopic interlaminar discectomyA Review of Hip-Spine SyndromeLumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data)Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks for the Treatment of Pain in the Rehabilitation Patient 3 May 2016Volume 164, Issue 9Page: 635-636KeywordsAnestheticsDisclosureHealth services researchLower back painObservational studiesRandomized trialsResearch quality assessmentSoft tissuesStenosisSystematic reviews ePublished: 3 May 2016 Issue Published: 3 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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