title: Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials.
abstract: BACKGROUND
  Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain.
  
  
  METHODS
  A systematic literature search was conducted to identify randomized controlled trials (RCTs) which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies.
  
  
  RESULTS
  10 RCTs (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief. And the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores (95% CI: -4.26, -3.91), and 4.12 (95% CI: -4.35, -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% of patients in group 2 achieved significantly improved functional status. The Oswestry Disability Index in the two groups were reduced by 14.5 (95% CI: -15.24, -13.75) and 12.37 (95% CI: -16.13, -8.62), respectively. The average procedures per year in group 1 was 3.68 ± 1.17 and 3.68 ± 1.26 in group 2 with an average total relief per year of 31.67 ± 13.17 weeks and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI: -12.24, -5.38) and 16.92 mg (95% CI: -22.71, -11.12) in the two groups, respectively.
  
  
  CONCLUSIONS
  This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low back and lower extremity pain.
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Jinshuai
authors: J
authors: Zhai
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Long
authors: L
authors: Zhang
authors: Public Health, People's Hospital of Hebei Province China.
authors: Mengya
authors: M
authors: Li
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Yiren
authors: Y
authors: Tian
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Wang
authors: W
authors: Zheng
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Jia
authors: J
authors: Chen
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Teng
authors: T
authors: Huang
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Xicheng
authors: X
authors: Li
authors: Second Department of Orthopedics, People's Hospital of Hebei Province China.
authors: Zhi
authors: Z
authors: Tian
keywords: Chronic low back pain; epidural injections; local anesthetic; lower extremity pain; meta-analysis; steroids