Effectiveness and Safety of Epidural Corticosteroid Injections for the Treatment of Low Back Pain: A Systematic Review with Meta-Analysis

• Grant number: 23/05983-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: November 01, 2023
• End date: October 31, 2024
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Crystian Bitencourt Soares de Oliveira
• Grantee: Paulo Victor Pires Matias
• Host Institution: Faculdade de Medicina Dr Domingos Leonardo Ceravolo. Universidade do Oeste Paulista (UNOESTE). Campus de Presidente Prudente. Presidente Prudente , SP, Brazil

Abstract

Introduction: Low back pain is a condition in which patients experience pain in the lower back region, extending from the lower rib margins to the gluteal folds. This manifestation can be associated with serious pathologies and root compression, and is also one of the leading causes of years lived with disability worldwide. Epidural corticosteroid injections release these substances into the epidural space with the aim of reducing the inflammatory process and, consequently, relieving symptoms of low back pain. This treatment has been indicated in some studies and refuted in others for the therapy of this condition. This review aims to update old studies on this intervention in order to assist professionals in making decisions regarding patients with this condition.Objectives: To analyze the efficacy and safety of epidural corticosteroid injections compared to saline injections or injections with anesthetic in the treatment of low back pain.Methods: Searches will be conducted in the following databases, with no restriction on publication date or language: Cochrane Central Register of Controlled Trial, MEDLINE, Embase, CINAHL, WHO and ICTRP. We will include randomized clinical trials that compared epidural corticosteroid injections with placebos or injections with anesthetic in the treatment of patients with low back pain. Two independent reviewers (A and B) will perform study selection, data extraction and management, risk of bias assessment, treatment effect measures, analysis unit problems and handle missing data. A third reviewer will be called in case of disagreement. The results will be analyzed separately considering four groups: immediate (less than or equal to 2 weeks), short-term (greater than two weeks but less than three months), medium-term (greater than three months but less than twelve months) and long-term (equal to or greater than 12 months).