Information de reference pour ce titreAccession Number: | 00000605-201204170-00002.
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Author: | Cohen, Steven P. MD; White, Ronald L. MD; Kurihara, Connie RN; Larkin, Thomas M. MD; Chang, Audrey PhD; Griffith, Scott R. MD; Gilligan, Christopher MD; Larkin, Ralph PhD; Morlando, Benny RN; Pasquina, Paul F. MD; Yaksh, Tony L. PhD; Nguyen, Conner MD
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Institution: | From Johns Hopkins School of Medicine, Baltimore, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany; Walter Reed National Military Medical Center, Bethesda, Maryland; Parkway Neuroscience and Spine Institute, Hagerstown, Maryland; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; John Jay College of Criminal Justice of the City University of New York, New York, New York; and University of California, San Diego, San Diego, California.
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Title: | |
Source: | Annals of Internal Medicine. 156(8):551-559, April 17, 2012.
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Abstract: | 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 computer-generated 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 short-term 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.
(C) 2012 American College of Physicians
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Language: | English.
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Document Type: | Original Research.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0003-4819
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NLM Journal Code: | 0372351, 5a6
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