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

Research output: Contribution to journalArticle

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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

Fingerprint

Epidural Injections
Neck Pain
Steroids
Outcome Assessment (Health Care)
Therapeutics
Pain
Nortriptyline
Conservative Treatment

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Cohen, Steven P. ; Hayek, Salim ; Semenov, Yevgeny ; Pasquina, Paul F. ; White, Ronald L. ; Veizi, Elias ; Huang, Julie H.Y. ; Kurihara, Connie ; Zhao, Zirong ; Guthmiller, Kevin B. ; Griffith, Scott R. ; Verdun, Aubrey V. ; Giampetro, David M. ; Vorobeychik, Yakov. / Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain : A multicenter, randomized, comparative-effectiveness study. In: Anesthesiology. 2014 ; Vol. 121, No. 5. pp. 1045-1055.
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title = "Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study",
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.",
author = "Cohen, {Steven P.} and Salim Hayek and Yevgeny Semenov and Pasquina, {Paul F.} and White, {Ronald L.} and Elias Veizi and Huang, {Julie H.Y.} and Connie Kurihara and Zirong Zhao and Guthmiller, {Kevin B.} and Griffith, {Scott R.} and Verdun, {Aubrey V.} and Giampetro, {David M.} and Yakov Vorobeychik",
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Cohen, SP, Hayek, S, Semenov, Y, Pasquina, PF, White, RL, Veizi, E, Huang, JHY, Kurihara, C, Zhao, Z, Guthmiller, KB, Griffith, SR, Verdun, AV, Giampetro, DM & Vorobeychik, Y 2014, 'Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study', Anesthesiology, vol. 121, no. 5, pp. 1045-1055. https://doi.org/10.1097/ALN.0000000000000409

Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain : A multicenter, randomized, comparative-effectiveness study. / Cohen, Steven P.; Hayek, Salim; Semenov, Yevgeny; Pasquina, Paul F.; White, Ronald L.; Veizi, Elias; Huang, Julie H.Y.; Kurihara, Connie; Zhao, Zirong; Guthmiller, Kevin B.; Griffith, Scott R.; Verdun, Aubrey V.; Giampetro, David M.; Vorobeychik, Yakov.

In: Anesthesiology, Vol. 121, No. 5, 04.11.2014, p. 1045-1055.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain

T2 - A multicenter, randomized, comparative-effectiveness study

AU - Cohen, Steven P.

AU - Hayek, Salim

AU - Semenov, Yevgeny

AU - Pasquina, Paul F.

AU - White, Ronald L.

AU - Veizi, Elias

AU - Huang, Julie H.Y.

AU - Kurihara, Connie

AU - Zhao, Zirong

AU - Guthmiller, Kevin B.

AU - Griffith, Scott R.

AU - Verdun, Aubrey V.

AU - Giampetro, David M.

AU - Vorobeychik, Yakov

PY - 2014/11/4

Y1 - 2014/11/4

N2 - 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.

AB - 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.

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