Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study

Steven Cohen, Salim Hayek, Yevgeny Semenov, Paul F. Pasquina, Ronald L. White, Elias Veizi, Julie H Y Huang, Connie Kurihara, Zirong Zhao, Kevin B. Guthmiller, Scott R. Griffith, Aubrey V. Verdun, David M. Giampetro, Yakov Vorobeychik

Research output: Contribution to journalArticle

Abstract

Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.

Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.

Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006).

Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-Alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

Original languageEnglish (US)
Pages (from-to)1045-1055
Number of pages11
JournalAnesthesiology
Volume121
Issue number5
StatePublished - Nov 4 2014

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Epidural Injections
Neck Pain
Steroids
Outcome Assessment (Health Care)
Therapeutics
Pain
Nortriptyline
Conservative Treatment

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain : A multicenter, randomized, comparative-effectiveness study. / Cohen, Steven; Hayek, Salim; Semenov, Yevgeny; Pasquina, Paul F.; White, Ronald L.; Veizi, Elias; Huang, Julie H Y; Kurihara, Connie; Zhao, Zirong; Guthmiller, Kevin B.; Griffith, Scott R.; Verdun, Aubrey V.; Giampetro, David M.; Vorobeychik, Yakov.

In: Anesthesiology, Vol. 121, No. 5, 04.11.2014, p. 1045-1055.

Research output: Contribution to journalArticle

Cohen, S, Hayek, S, Semenov, Y, Pasquina, PF, White, RL, Veizi, E, Huang, JHY, Kurihara, C, Zhao, Z, Guthmiller, KB, Griffith, SR, Verdun, AV, Giampetro, DM & Vorobeychik, Y 2014, 'Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study', Anesthesiology, vol. 121, no. 5, pp. 1045-1055.
Cohen, Steven ; Hayek, Salim ; Semenov, Yevgeny ; Pasquina, Paul F. ; White, Ronald L. ; Veizi, Elias ; Huang, Julie H Y ; Kurihara, Connie ; Zhao, Zirong ; Guthmiller, Kevin B. ; Griffith, Scott R. ; Verdun, Aubrey V. ; Giampetro, David M. ; Vorobeychik, Yakov. / Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain : A multicenter, randomized, comparative-effectiveness study. In: Anesthesiology. 2014 ; Vol. 121, No. 5. pp. 1045-1055.
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abstract = "Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.Results: One-month arm pain scores were 3.5 (95{\%} CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95{\%} CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95{\%} CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9{\%} of patients treated with combination therapy experienced a positive outcome versus 26.8{\%} in the conservative group and 36.7{\%} in ESI patients (P = 0.006).Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-Alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.",
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T2 - A multicenter, randomized, comparative-effectiveness study

AU - Cohen, Steven

AU - Hayek, Salim

AU - Semenov, Yevgeny

AU - Pasquina, Paul F.

AU - White, Ronald L.

AU - Veizi, Elias

AU - Huang, Julie H Y

AU - Kurihara, Connie

AU - Zhao, Zirong

AU - Guthmiller, Kevin B.

AU - Griffith, Scott R.

AU - Verdun, Aubrey V.

AU - Giampetro, David M.

AU - Vorobeychik, Yakov

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N2 - Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006).Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-Alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

AB - Background: Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy.Methods: A comparative-effectiveness study was performed in 169 patients with cervical radicular pain less than 4 yr in duration. Participants received nortriptyline and/or gabapentin plus physical therapies, up to three cervical epidural steroid injections (ESI) or combination treatment over 6 months. The primary outcome measure was average arm pain on a 0 to 10 scale at 1 month.Results: One-month arm pain scores were 3.5 (95% CI, 2.8 to 4.2) in the combination group, 4.2 (CI, 2.8 to 4.2) in ESI patients, and 4.3 (CI, 2.8 to 4.2) in individuals treated conservatively (P = 0.26). Combination group patients experienced a mean reduction of -3.1 (95% CI, -3.8 to -2.3) in average arm pain at 1 month versus -1.8 (CI, -2.5 to -1.2) in the conservative group and -2.0 (CI, -2.7 to -1.3) in ESI patients (P = 0.035). For neck pain, a mean reduction of -2.2 (95% CI, -3.0 to -1.5) was noted in combination patients versus -1.2 (CI, -1.9 to -0.5) in conservative group patients and -1.1 (CI, -1.8 to -0.4) in those who received ESI; P = 0.064). Three-month posttreatment, 56.9% of patients treated with combination therapy experienced a positive outcome versus 26.8% in the conservative group and 36.7% in ESI patients (P = 0.006).Conclusions: For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-Alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.

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