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Transforaminal steroid injection for lumbar radicular pain proves superior to placebo
Date:7/29/2010

o achieved complete relief of pain or at least 50% relief, at one month after treatment. Secondary outcome measures were function, disability, patient-specified functional outcomes, and use of other health care, and duration of relief beyond one month.

A significantly greater proportion of patients treated with transforaminal injection of steroid (54%) achieved relief of pain than did patients treated with transforaminal injection of local anaesthetic (7%) or transforaminal injection of saline (19%), intramuscular steroids (21%) or intramuscular saline (13%). Relief of pain was corroborated by clinically significant improvements in function and disability, and reductions in use of other health care. Outcomes were equivalent for patients with acute or chronic radicular pain. Twenty-five percent maintained relief beyond 12 months.

Study leader Dr. Bogduk concludes, "In essence, transforaminal injection of steroids is a viable alternative to surgery for lumbar radicular pain due to disc herniation. Its immediate yield is modest, but substantial, and is not simply a placebo effect. For long-term efficacy, proof beyond reasonable doubt would require prohibitively large studies."

Editorial author Dr. Ray Baker concurs. "The study results are particularly impressive given the stringent study design." Dr. Baker also praises the team's method of analysis, the number needed to treat (NNT) measure of treatment effect, stating, "From Bogduk's analysis, one can easily grasp that every third patient will be significantly improved beyond what an intramuscular injection of steroid or a transforaminal injection of normal saline can offer. More to the point, one can observe that one in four patients will retain significant benefit with transforaminal injection of steroids at 12 months, while avoiding the cost of surgery. In the end, this landmark study has vindicated transforaminal steroid injection for lumbar radicular pain as superior to placebo. Furthe
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Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

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