Non-Operative Treatments Relieve Leg Pain Only Briefly

Epidural steroid injections and gabapentin lower pain scores and boost functional capacity, but differences between the two modalities are small and results are transitory.

Cohen SP, Hanling S, Bicket MC, et al. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study.BMJ 2015; 350:h1748 doi: 10.1136/bmj.h1748. April 16, 2015.

Epidural steroid injections may outdo gabapentin on some outcome measures for lumbosacral radiculopathy, but the differences between the two approaches are usually modest and transient, according to this study.

“These results are readily generalizable to primary care settings, pain clinics, and spine surgery centers, where practitioners are often faced with the question about the best non-operative way to manage lumbosacral radicular pain,” the authors state.

Patients in the trial had had lumbosacral radicular pain secondary to herniated disk or spinal stenosis for 4 or less years. Their leg pain was as severe or more severe than back pain.

The 145 patients were randomized to receive epidural steroid injections (plus placebo pills) or gabapentin (plus sham injection).

The authors report no significant differences in the primary outcome: a >2 point reduction in leg pain and perceived global effect (on a 1-10 scale) at 1 and 3 months. Among secondary outcomes, patients with the worst leg pain who had epidural steroid injections saw greater reductions at 1 month. But differences between the two modalities faded at 3 months.

The trial included patients admitted to military, Veterans Administration, and civilian hospitals.