Evidence-Based Poste

Date: 25 January, 2021.

EBP Question:  The Use of Steroids Injections for Chronic or Acute Pain

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

1.

Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S. M., ... & Park, B. J. (2013).

Systematic review of RCTs, with meta- analysis

29 articles of randomized control trials of database searches

· Epidural steroid injection did not provide improvement of back pain disability more other methods.

· Epidural steroid injection failed to decrease the number of patients that attended subsequent surgery.

· Weight mean difference.

· Number of months.

· Percent confidence interval.

The article did not provide evidence-based recommendations for the results.

Level I

High Quality

2.

El Abd, O., Amadera, J., Pimentel, D. C., & Gomba, L. (2015).

Explanatory mixed method design that includes only a level I quantitative study

150 consecutive patients receiving TFSI.

Setting is a spine center associated with a rehabilitation hospital.

· Transforaminal Epidural Steroid Injections with dexamethasone offers minor self-limited transient adverse effects which can be managed easily.

· Adverse effects in a period if two weeks.

· Intensity and duration of side effects.

The sample size enrolled was too small to provide proper evidence of the results.

Level I

Good quality

3.

Brose, S. W., Montfort, J., Gustafson, K. J., Mittebrun, I., Gauriloff, S., Mosher, M., & Bourbeau, D. J. (2017).

Opinion of respected authorities

1 Patient

70-year-old man with paraplegia suffering from multifocal degenerative wrist pain.

· Corticosteroid injection of the pisotriquetral joint under ultrasound guidance is effective in the management of wrist pain stemming from that joint. 

· Bleeding and bruising after injections.

· Pain resolution after the injections

The sample size is way too low to draw any evidence-based conclusions.

Level IV

Good Quality.

4.

Kennedy, D. J., Plastaras, C., Casey, E., Visco, C. J., Rittenberg, J. D., Conrad, B., ... & Dreyfuss, P. (2014).

Randomized Control Test

78 subjects suffereing from acute uni-level disc herniation leading to unilateral radicular pain.

· Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation

· only require 1 or 2 injections for symptomatic relief

· Dexamethasone displays possession of rationally parallel effectiveness in comparison with triamcinolone.

· Surgical rates

· Injections received

· Categorical scores of pains

· Mean Oswestry Disability Index.

No recommendations were provided after the results.

Level I

Good Quality.

5.

Cohen, S. P., Hanling, S., Bicket, M. C., White, R. L., Veizi, E., Kurihara, C., ... & Pasquina, P. F. (2015).

Randomized Control Trial

· Military, Veteran, and civilian hospitals.

· 145 participants with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years.

· The patients had equal or more severe leg pain compared to back pain.

· N/A

· The differences between epidural steroid injection and gabapentin are modest and transient for most people.

· Average leg pain after the injection.

· The study did not have a true placebo group.

Level I

Good quality.

6.

Yürük, D., Yılmaz, A., Özgencil, G. E., & Aşık, İ. (2019).

Opinion of respected authorities

One 47-year-old patient.

· Epidural steroid injection leads to complications such as the rhabdomyolysis.

· Patient status pre- and post-the steroid injection.

The sample size is too small to draw any evidence-based conclusions.

Level IV

Good quality.

· N/A

Date:

EBP Question:

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

7.

Cui, J. Z., Zhang, X. B., Zhu, P., Zhao, Z. B., Geng, Z. S., Zhang, Y. H., ... & Feng, J. Y. (2017).

Randomized Control Trial

93 participants with acute thoracic HZ.

· Repetitive intracutaneous injections with local anesthetics and steroids together with standard treatment greatly decrease the length of pain and herpetic eruption and incidence of PHN.

· Severity of pain

· Time of complete resolution

Lack of previous study on the effectiveness of intracutaneous injections with local anesthetics and corticosteroids to support the study.

Level I

High Quality

8.

Darrieutort-Laffite, C., Varin, S., Coiffier, G., Albert, J. D., Planche, L., Maugars, Y., ... & Le Goff, B. (2019).

Randomized controlled trial.

132 patients with 5mm symptomatic clarification.

· Steroids greatly improve VAS pain at rest and during activities, and function at 7 days and 6 weeks.

· Steroids do not change the rate of calcification resorption.

· Mean difference of maximal pain

· Pain at rest

· Pain during activity

· radiological evolution of the calcification

No recommendations after the results were provided by the study.

Level I

Good quality.

9.

Schreiber, A. L., McDonald, B. P., Kia, F., & Fried, G. W. (2016).

A retrospective study.

1343 patients with acute spinal cord injuries.

· Increased use of interventional spine procedures to treat pain, do not increase the proportion of cervical epidural-related SCI admissions.

· characteristics of patients and proportion of SCI admissions to cervical epidural injections injuries

The sample were from earlier years 2001 to 2008. There is need for research in the span of recent years.

Level II

Good quality.

10.

Kennedy, D. J., Zheng, P. Z., Smuck, M., McCormick, Z. L., Huynh, L., & Schneider, B. J. (2018).

Retrospective cohort study.

78 subjects

with single leg radicular pain rating ≥4/10 for less than 6 months' duration, with radiographic imaging demonstrating an anatomically congruent single-level herniated nucleus pulposus.

·  Lumbar disc herniation can be successfully treated in the short-term by transforaminal epidural steroid injections

or surgery, but long-term recurrence rates are high regardless of treatment received.

· Presence of recurrent or persistent pain

· current opioid use for radicular symptoms

· pain within the previous week

· spine injections for radicular pain, progression to surgery,

The study did not provide any recommendations for the results it presented.

Level III

Good Quality

· N/A

· N/A

· N/A