Date of Award

2016

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Do epidural injections with local anesthetic with steroids have superiority over injections with local anesthetic alone when treating chronic back pain due to an intervertebral disc herniation in men and women over 18 years old?”

STUDY DESIGN: Review of three, double blind, randomized controlled trials (RCTs) published between 2011-2014, all in English language. The articles compared epidural injections containing local anesthetic with steroids to epidural injections containing local anesthetics alone.

DATA SOURCES: Three Randomized controlled trials found using PubMed. All articles were published in peer-reviewed journals and selected based on the correlation to topic choice, publication dateold, RCT’s, and dealt with POEMs.

OUTCOMES MEASURED: The outcomes were measured using questionnaires such as the Numeric Rating Scale (NRS) 0(none)-10 (severe) pain scale and Oswestry Disability Index (ODI) 0(minimal)-50(severe) scale to assess functional status. Significant improvement (> 50%) pain relief associated with >50% improvement in functional status measured by and Neck Disability Index. 3,6,12 month post treatment assessments were also completed for pain and opioid use, classified via dosage frequency and schedule of the drug.

RESULTS: All three studies revealed both treatments (steroids vs anesthetic alone) are effective for pain improvement, but steroids have no superiority. One of the Manchikanti et al. studies showed a negative result of the steroid group. Significant improvement from baseline in 80% of local anesthetic group and 73% of local anesthetic plus steroid group via ODI and NRS, p-value = 0.357, ABI of -0.07%, NNT of -14.1 The other two Manchikanti et al. studies displayed a greater improvement from baseline in the local anesthetic plus steroid group vs local anesthetic group alone, but no significance when compared.

CONCLUSION: The three RCT’s showed significant improvement from baseline, but treatment effects between steroid group and exclusively anesthetic group was not statistically different. In conclusion, steroid injections improve pain and function in those with chronic back pain due to an intervertebral disc herniation, but did not statistically show more improvement over the control.

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