title: Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials.
abstract: BACKGROUND
  Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone.
  
  
  METHODS
  PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies.
  
  
  RESULTS
  We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups.
  
  
  CONCLUSIONS
  Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic alone.
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Hai
authors: H
authors: Meng
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Qi
authors: Q
authors: Fei
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Bingqiang
authors: B
authors: Wang
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Yong
authors: Y
authors: Yang
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Dong
authors: D
authors: Li
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Jinjun
authors: J
authors: Li
authors: Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Nan
authors: N
authors: Su
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000503:physiopathology; D016017:Odds Ratio; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012074:Remission Induction; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D013256:Steroids
keywords: chronic low back pain; epidural injections; local anesthetics; spinal stenosis; steroids