Epidural steroid injections do not offer any extra benefit to people with lower back conditions such as disc herniation when compared with gabapentin, researchers have reported in the BMJ.
The team found both approaches resulted in improvements in pain scores and function – but any additional benefits of the steroid injections were small and short-lived.
The researchers said patients should therefore be offered a trial of neuropathic drugs as a first-line option.
The study included 145 people with lumbosacral radicular pain that was secondary to a herniated disc or spinal stenosis, and whose leg pain that was at least as severe as their back pain.
The patients were either given the epidural steroid injections and placebo pills, or sham injections and gabapentin.
Results showed there was no difference in the primary outcome – an improvement of at least two points on a 0-10 pain rating scale, along with a global improvement – between the two groups at either one or three months.
Patients who underwent the steroid injections reported slightly bigger improvements in leg pain and an overall more successful outcome at one month than the gabapentin group, but these differences did not last through to three months.
The study’s authors concluded: ‘Gabapentin and epidural steroid injections used to treat lumbosacral radicular pain both resulted in modest improvements in pain and function, which persisted through three months.
‘Although some differences favoured epidural steroid injections, these tended to be small and transient. The similar outcomes… suggest that a trial with neuropathic drugs might be a reasonable first line treatment option.’