Anesthesia Management: Epidural Steroids for Cervical Radicular Pain: Little Benefit

Authors: Cohen SP et al., Anesthesiology 2014 Nov 121:1045

In a nonblinded, randomized trial, epidural steroid injections were not significantly better than conservative treatment.

Data on epidural steroid injections for cervical radiculopathy are largely observational, and results of the few small randomized trials have been inconclusive. In this multicenter trial, U.S. investigators randomized 169 patients with arm pain attributed to cervical radiculopathy to receive either single initial epidural steroid injections (which could be repeated at 1 month and 3 months, if needed), drug therapy (gabapentin or nortriptyline) plus physical therapy, or both interventions. Criteria for enrollment included pain duration of 1 month to 4 years (median duration, 0.8 years) and magnetic resonance imaging findings that supported clinical presentation.

At 1 month, arm-pain scores (the primary outcome) improved in all three groups, with no statistically significant differences between groups. Additionally, the groups did not differ in patient-reported satisfaction and global improvement in pain. On various other secondary endpoints at 1, 3, and 6 months, some trends favored combination treatment over epidural steroid injections alone or oral medication plus physical therapy alone, but most differences did not reach statistical significance.

Comment
In this nonblinded study, most patients with cervical radiculopathy derived little or no benefit from cervical epidural steroid injections.