Evidence map›Paper›PMID 35604636›Full record

ArticleEuropean journal of pain (London, England)2022

Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.

Michele Curatolo, Sean D Rundell, Laura S Gold, P Suri, Janna L Friedly, Sdrj S Nedeljkovic, Richard A Deyo, Judith A Turner, Brian W Bresnahan, Andrew L Avins and 3 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of pain (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 20% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Article
  5. Review
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  7. Article
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  9. Response to the comment by Van Boxem.European journal of pain (London, England) · 2023
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 1 country.

Michele CuratoloDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.ORCID 0000-0003-4130-6826
Sean D RundellEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Laura S GoldEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
P SuriEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Janna L FriedlyEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Sdrj S NedeljkovicDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Spine Unit, Harvard Vanguard Medical Associates, Boston, MA, USA.
Richard A DeyoEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Judith A TurnerEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Brian W BresnahanEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Andrew L AvinsDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Larry KesslerEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Patrick J HeagertyEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
Jeffrey G JarvikEvidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.
University of Washington · USBrigham and Women's Hospital · USKaiser Permanente · USOregon Health & Science University · US

Funding

Back pain Outcomes using Longitudinal Data (BOLD)R01HS019222 · AHRQ · UNIVERSITY OF WASHINGTON · PI JARVIK, JEFFREY G · 2010 to 2010
$9.9M
UW Core Center for Clinical Research of Musculoskeletal ConditionsP30AR072572 · NIAMS · UNIVERSITY OF WASHINGTON · PI JEFFREY G JARVIK, Pradeep Suri · 2017 to 2026
$8.3M
Back pain Outcomes using Longitudinal Data- Extension of Research (BOLDER)R01HS022972 · AHRQ · UNIVERSITY OF WASHINGTON · PI JARVIK, JEFFREY G · 2013 to 2013
$741k
AHRQ HHS R01 HS019222AHRQ HHS R01 HS022972NIAMS NIH HHS P30 AR072572
6 · The paper itself

Abstract

backgroundThere is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: (1) have worse pain, disability and quality of life ('outcomes') pre-ESI, (2) have improved outcomes after ESI and (3) have improved outcomes due to a specific ESI effect.

methodsWe prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3-, 6-, 12- and 24-month follow-ups. We categorized participants as: (1) ESI within 6 months from the index visit (n = 295); (2) no ESI within 6 months (n = 4809); (3) no ESI within 6 months, propensity-score matched to group 1 (n = 483). We analysed the data using linear regression and Generalized Estimating Equations.

resultsPain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24 months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between outcome trajectories for the propensity-score matched groups 1 and 3.

conclusionsOlder adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect. SIGNIFICANCE: In this large, two-year, prospective study in older adults with a new episode of low back pain, back pain, leg pain, disability and quality of life improved after epidural steroid injections; however, propensity-score matching revealed that the improvement was unlikely the result of a specific effect of the injections, indicating that epidural steroids are unlikely to provide long-term benefits in older adults with new episodes of back and leg pain.

Indexed as

Low Back PainAgedBack PainHumansInjections, EpiduralProspective StudiesQuality of LifeSteroidsTreatment OutcomeSteroids

Identifiers

PMID35604636
PMCPMC9296573
OpenAlexW4281393459

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.