Evidence map›Paper›PMID 25883095›Full record

Trial reportBMJ (Clinical research ed.)2015

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study.

Steven P Cohen, Steven Hanling, Mark C Bicket, Ronald L White, Elias Veizi, Connie Kurihara, Zirong Zhao, Salim Hayek, Kevin B Guthmiller, Scott R Griffith and 4 more

Registry-linked trialOpen access · hybridAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01495923 (Randomized, Double-blind, Comparative-effectiveness Study Comparing Epidural Steroid Injections to Gabapentin in Patients With Lumbosacral Radiculopathy), which is not on this map. Cited by 29 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 5 pooled it
12.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01495923 nacompletednot on this map

Randomized, Double-blind, Comparative-effectiveness Study Comparing Epidural Steroid Injections to Gabapentin in Patients With Lumbosacral Radiculopathy

TypeinterventionalSponsorJohns Hopkins UniversityRan2011 to 2014Enrolled145ConditionsSciatica, RadiculopathyArmsepidural steroid injection, Sham epidural steroid injection, Gabapentin, Placebo gabapentin
3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 5 syntheses or guidelines pooled it, 86 citations in OpenAlex.

  1. Pooled it
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  3. Epidural corticosteroid injections for lumbosacral radicular pain.The Cochrane database of systematic reviews · 2020
    Pooled it
  4. Pooled it
  5. Gabapentin for chronic neuropathic pain in adults.The Cochrane database of systematic reviews · 2017
    Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 10 institutions in 2 countries.

Steven P CohenBlaustein Pain Treatment Center, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA Blaustein Pain Treatment Center, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA scohen40@jhmi.edu.
Steven HanlingPain Medicine Division, Department of Anesthesiology, Naval Medical Center-San Diego, USA.
Mark C BicketDepartment of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA.
Ronald L WhiteInterdisciplinary Pain Medicine, Department of Surgery, Landstuhl, Regional Medical Center, Landstuhl, Germany.
Elias VeiziPain Medicine Service Department of Anesthesiology, Louis Stokes Cleveland VA Medical Center, Case Western University, Cleveland, OH, USA.
Connie KuriharaAnesthesia Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Zirong ZhaoDepartment of Neurology, District of Columbia VA Hospital, Washington DC, MD, USA Department of Medicine, George Washington University, Washington DC, MD, USA.
Salim HayekPain Medicine Division, Department of Anesthesiology, Case Western Reserve School of Medicine, Cleveland, OH, USA.
Kevin B GuthmillerInterdisciplinary Pain Management Clinic, Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX, USA Pain Medicine Fellowship Program, Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX, USA.
Scott R GriffithWalter Reed National Military Medical Center, Bethesda, MD, USA.
Vitaly GordinPain Medicine Division, Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, PA, USA.
Mirinda Anderson WhiteDepartment of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Yakov VorobeychikDepartments of Anesthesiology and Neurology, Penn State Hershey Medical Center, Hershey, PA, USA.
Paul F PasquinaDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Walter Reed National Military Medical Center · USJohns Hopkins University · USPenn State Milton S. Hershey Medical Center · USCase Western Reserve University · USGeorge Washington University · USLandstuhl Regional Medical Center · DELouis Stokes Cleveland VA Medical Center · USMassachusetts General Hospital · USNaval Medical Center San Diego · USSan Antonio Military Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.

designA multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes. SETTINGS: Eight military, Veterans Administration, and civilian hospitals.

participants145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain.

interventionsParticipants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin.

main outcome measuresAverage leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥ 2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit.

resultsThere were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline -2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and -1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval -0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline -2.0 (SD 2.6) versus 3.7 (SD 2.8) and -1.6 (SD 2.7), respectively; adjusted difference 0.3, -0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (-3.0, SD 2.8) than those treated with gabapentin (-2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three months, there were no significant differences between treatments.

conclusionsAlthough epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.Trial registration ClinicalTrials.gov Identifier: NCT01495923.

Indexed as

AdultAminesAnalgesicsAnalysis of VarianceAnti-Inflammatory AgentsCyclohexanecarboxylic AcidsDouble-Blind MethodFemaleGabapentingamma-Aminobutyric AcidHumansInjections, EpiduralLow Back PainMaleMethylprednisoloneMiddle AgedAminesAnalgesicsAnti-Inflammatory AgentsCyclohexanecarboxylic AcidsGabapentingamma-Aminobutyric AcidMethylprednisolone

Identifiers

PMID25883095
PMCPMC4410617
OpenAlexW2112182295

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.