Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study

Steven P. Cohen, Salim Hayek, Yevgeny Semenov, Paul F. Pasquina, Ronald L. White, Elias Veizi, Julie H.Y. Huang, Connie Kurihara, Zirong Zhao, Kevin B. Guthmiller, Scott R. Griffith, Aubrey V. Verdun, David M. Giampetro, Yakov Vorobeychik

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Abstract

Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.

Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.

Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006).

Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-Alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

Original languageEnglish (US)
Pages (from-to)1045-1055
Number of pages11
JournalAnesthesiology
Volume121
Issue number5
DOIs
StatePublished - Nov 4 2014

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All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Cohen, S. P., Hayek, S., Semenov, Y., Pasquina, P. F., White, R. L., Veizi, E., Huang, J. H. Y., Kurihara, C., Zhao, Z., Guthmiller, K. B., Griffith, S. R., Verdun, A. V., Giampetro, D. M., & Vorobeychik, Y. (2014). Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study. Anesthesiology, 121(5), 1045-1055. https://doi.org/10.1097/ALN.0000000000000409