title: Randomized Double-Blind Controlled Trial Comparing the Effectiveness of Lumbar Transforaminal Epidural Injections of Particulate and Nonparticulate Corticosteroids for Lumbosacral Radicular Pain.
abstract: OBJECTIVE
  To compare equivalent doses of a nonparticulate (dexamethasone) with a particulate (betamethasone) corticosteroid in lumbar transforaminal epidural steroid injections (TFESIs) in terms of pain, function, and complications.
  
  
  METHODS
  Fifty-six patients presenting with debilitating radicular pain were randomized in a double-blind controlled trial to receive a lumbar transforaminal injection of either dexamethasone 7.5 mg (n = 29) or betamethasone 6.0 mg (n = 27).
  
  
  METHODS
  A pain clinic and physical medicine and rehabilitation department in two academic hospital centres.
  
  
  METHODS
  Data were collected at 1-, 3-, and 6-month follow-ups. The primary outcome was pain reduction on a visual analog scale (VAS) at 3 months. Secondary outcomes were functional improvement, as measured by the Oswestry Disability Index (ODI), and number and type of complications.
  
  
  RESULTS
  No differences on the VAS, analyzed either as a continuous (P = 0.209) or categorical variable (≥50% (P = 0.058) or ≥75% (P = 0.865) improvement) and ODI (P = 0.181) were found between the two groups at 3 months. At 6 months, improvement of ODI score was at the limit of statistical significance in favor of dexamethasone (P = 0.050). Multivariate regression analysis, adjusting for potential confounding variables, showed that differences on the ODI became statistically significant at the 6 month follow-up, also in favor of dexamethasone (adjusted P = 0.003). No serious complications were observed in either group.
  
  
  CONCLUSIONS
  According to this study, pain relief and functional improvement are similar for both dexamethasone and betamethasone at 3 months. Considering its safety profile, dexamethasone could be considered as first choice for TFESI. However, given that the study was underpowered, more research is needed to support a recommendation of systematically using dexamethasone in TFESI.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal- Hôpital Notre-Dame, Montréal, Québec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Denis
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital de la Cité-de-la-Santé, Laval, Québec, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Claveau
authors.affiliation: Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal- Hôpital Notre-Dame, Montréal, Québec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Filiatrault
authors.affiliation: Department of Anesthesiology, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Fugère
authors.affiliation: Institut de Physiatrie du Québec, Montréal, Québec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Fortin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy*; D020127:Recovery of Function / Q000187:drug effects
chemical_list: D000305:Adrenal Cortex Hormones; D003907:Dexamethasone; D001623:Betamethasone
keywords: Betamethasone; Dexamethasone; Lower Limb Pain; Nonparticulate and Particulate Steroids; Transforaminal Epidural Injection