Winter 2007 - Vol.2, No.4

To the Editor:

Re: Back Pain and Needles in the Fall, 2007 JLGH;[1] Peul, et al, reported results in the New England Journal of Medicine of a controlled study of 283 patients with sciatica, comparing early surgery with conservative treatment, and based conclusions on carefully analyzed results.[2]

Dr. James Artuso advocated that “ESI should be part of a multimodal approach to reduce painful symptoms,” even though “controlled studies of outcomes have been—at best—limited….” He does not offer evidence to validate the “contemporary techniques” he recommends, techniques that “may rarely lead to… permanent neurological injury and death.”

Guidelines of the American Academy of Neurology[3] state, in part:

“1)…epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments. The average magnitude of effect is small and generalizability of the observation is limited…. 2) in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended….”(2)

Genuine evidence to support an update of these guidelines would be welcome.

Carl Ellenberger, MD
Mt. Gretna, PA 17064

[1] Artuso, JD. Back Pain and Needles: Epidural Steroid Injections for Radicular Back Pain. J Lanc Gen Hosp. 2007; 2:95-100.

[2] Peul WC, van Houwelingen HC, van den Hout WB, et al, Surgery versus Prolonged Conservative Treatment for Sciatica. 2007, N Engl J Med;356:2245-56

[3] Armon C, Argoff CE, Samuels J, et al, Use of epidural steroid injections to treat radicular lumbosacral pain. Neurology, 2007;68:723–729