Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis.
OBJECTIVE
Perineural steroids are often used to treat chronic peripheral neuropathic pain (NP) secondary to trauma or compression. Nevertheless, when compared with local anesthetics (LA) or conventional medical management (CMM), their efficacy and safety in patients with trauma or compression-related neuropathic pain syndromes is unclear. The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of perineural steroids in compression or trauma-related NP after one to three months of injection.


METHODS
We reviewed randomized controlled trials from MEDLINE(®), EMBASE™, Cochrane central register of controlled trials, Cochrane database of systematic reviews, and Google Scholar (first 200 hits) up to April 2014 that compared perineural injections of steroids with LA or CMM in adult patients with trauma or compression-related chronic peripheral NP. A meta-analysis was performed on the data on pain scores measured at one to three months after the interventions. Quality of evidence was classified using the GRADE system. Two authors independently reviewed all identified titles and abstracts for eligibility.


RESULTS
Five trials comprising 353 patients (177 in the steroid group and 176 in the comparator groups) were included. At one to three months after the interventions, patients who received perineural steroids reported lower pain scores than those who received LA or CMM (mean difference: -1.31 points on a 0-10 numerical rating scale for pain; 95% confidence interval: -2.50 to -0.13; quality of evidence: low; I(2) = 89%). None of the studies reported any significant adverse effects.


CONCLUSIONS
Perineural steroids may provide analgesic efficacy for one to three months in patients with chronic peripheral NP of traumatic or compressive origin; however, the strength of this recommendation is weak. Well-designed large randomized studies are required.
Department of Anesthesia and Pain Management, and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada, anuj.bhatia@uhn.ca.
Anuj
A
Bhatia
David
D
Flamer
Prakesh S
PS
Shah
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007267:Injections; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000779:Anesthetics, Local; D005938:Glucocorticoids