title: Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? A double-blind randomised controlled trial.
abstract: OBJECTIVE
  To assess the effect of a single dose of intravenous dexamethasone in addition to routine treatment on visual analogue scale (VAS) pain scores at 24 h in emergency department (ED) patients with low back pain with radiculopathy (LBPR).
  
  
  METHODS
  Double-blind randomised controlled trial of 58 adult ED patients with LBPR, conducted in one tertiary and one urban ED. The intervention was 8 mg of intravenous dexamethasone (or placebo) in addition to current routine care. The primary outcome was the change in VAS pain scores between presentation and 24 h. Secondary outcomes included VAS pain scores at 6 weeks, ED length of stay (EDLOS), straight leg raise (SLR) angles and Oswestry functional scores.
  
  
  RESULTS
  Patients treated with dexamethasone had a 1.86 point (95% CI 0.31 to 3.42, p=0.019) greater reduction in VAS pain scores at 24 h than placebo (dexamethasone: -2.63 (95% CI -3.63 to -1.63) versus placebo: -0.77 (95% CI -2.04 to 0.51)). At 6 weeks, both groups had similar significant and sustained decrease in VAS scores compared with baseline. Patients receiving dexamethasone had a significantly shorter EDLOS (median: 3.5 h vs 18.8 h, p=0.049) and improved SLR angle at discharge (14.7°, p=0.040). There was no difference in functional scores.
  
  
  CONCLUSIONS
  In patients with LBPR, a single dose of intravenous dexamethasone in addition to routine management improved VAS pain scores at 24 h, but this effect was not statistically significant at 6 weeks. Dexamethasone may reduce EDLOS and can be considered as a safe adjunct to standard treatment.
  
  
  BACKGROUND
  ACTRN12611001020976.
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia Mater Hospital, South Brisbane, Queensland, Australia.
authors.forename: Ravichandra
authors.initials: R
authors.lastname: Balakrishnamoorthy
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia Princess Alexandra Hospital, Woolloongabba Queensland, Australia.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Horgan
authors.affiliation: Emergency Department, Gold Coast Health Service District, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Perez
authors.affiliation: Department of Mathematical and Computing Sciences, Universiti Brunei Darussalam, Brunei, Brunei Darussalam Griffith Graduate Research School, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Michael Craig
authors.initials: MC
authors.lastname: Steele
authors.affiliation: Emergency Department, Gold Coast Health Service District, Gold Coast University Hospital, Southport, Queensland, Australia School of Medicine, Bond University, Gold Coast, Queensland, Australia School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Gerben B
authors.initials: GB
authors.lastname: Keijzers
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: analgesia/pain control; musculo-skeletal, non traumatic problems