title: Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study.
abstract: OBJECTIVE
  To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.
  
  
  METHODS
  A multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes.
  
  
  METHODS
  Eight military, Veterans Administration, and civilian hospitals.
  
  
  METHODS
  145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain.
  
  
  METHODS
  Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin.
  
  
  METHODS
  Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥ 2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit.
  
  
  RESULTS
  There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline -2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and -1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval -0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline -2.0 (SD 2.6) versus 3.7 (SD 2.8) and -1.6 (SD 2.7), respectively; adjusted difference 0.3, -0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (-3.0, SD 2.8) than those treated with gabapentin (-2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three months, there were no significant differences between treatments.
  
  
  CONCLUSIONS
  Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.Trial registration ClinicalTrials.gov Identifier: NCT01495923.
authors.affiliation: Blaustein Pain Treatment Center, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA Blaustein Pain Treatment Center, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA scohen40@jhmi.edu.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Naval Medical Center-San Diego, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Hanling
authors.affiliation: Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bicket
authors.affiliation: Interdisciplinary Pain Medicine, Department of Surgery, Landstuhl, Regional Medical Center, Landstuhl, Germany.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: White
authors.affiliation: Pain Medicine Service Department of Anesthesiology, Louis Stokes Cleveland VA Medical Center, Case Western University, Cleveland, OH, USA.
authors.forename: Elias
authors.initials: E
authors.lastname: Veizi
authors.affiliation: Anesthesia Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Kurihara
authors.affiliation: Department of Neurology, District of Columbia VA Hospital, Washington DC, MD, USA Department of Medicine, George Washington University, Washington DC, MD, USA.
authors.forename: Zirong
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Case Western Reserve School of Medicine, Cleveland, OH, USA.
authors.forename: Salim
authors.initials: S
authors.lastname: Hayek
authors.affiliation: Interdisciplinary Pain Management Clinic, Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX, USA Pain Medicine Fellowship Program, Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Guthmiller
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Griffith
authors.affiliation: Pain Medicine Division, Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Gordin
authors.affiliation: Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Mirinda Anderson
authors.initials: MA
authors.lastname: White
authors.affiliation: Departments of Anesthesiology and Neurology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Vorobeychik
authors.affiliation: Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pasquina
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D000893:Anti-Inflammatory Agents; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D008775:Methylprednisolone