Caudal epidural steroid injection: a randomized controlled trial.

Study Design:  Prospective study.

Study Rationale:  A recurrent phenomenon, the lifetime prevalence of low back pain has been reported as 54%-80%, while annual prevalence ranges from 15%-45%.1 It is also associated with enormous economic, societal, and health impact.2 India, being a developing country, has its problem compounded by the occupational compulsions in parts of the rural areas.3For some interventional therapies, like epidural steroid injections, utilization rates have increased dramatically.4,5,6,7,8,9 They have become one of the most commonly performed interventions in the United States for low back pain with radiculopathy.10CLINICAL QUESTION: Multiple systematic reviews,11 a meta-analysis,12 several guidelines,13 health technology assessments by insurers, and local medical review policies and coverage decisions have been published. However, controversy continues regarding the effectiveness of epidural steroid injections. In addition three types of epidurals, namely interlaminar, transforaminal, and caudal, with variable results complicate the picture for practice of interventional pain management. The underlying mechanism of action of epidurally administered steroid and local anesthetic injections is still not well understood and compounds the problem.14OBJECTIVE: To evaluate and update the effects of caudal epidural injection in the management of chronic low back pain and sciatica.Final Class of evidence-treatmentYes

Study Design:  RCT• Cohort Case control Case seriesMethods Concealed allocation (RCT)• Intention to treat (RCT)• Blinded/independent evaluation of primary outcome• F/U ≥ 85%• Adequate sample size•Control for confoundingOverall class of evidenceIIThe definiton of the different classes of evidence is available here.