Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain A Multicenter, Randomized, Comparative-effectiveness Study
Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain A Multicenter, Randomized, Comparative-effectiveness Study
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DOI：
10.1097/aln.0000000000000409
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发表时间：
2014-11-01
期刊：
影响因子：
8.8
通讯作者：
Vorobeychik, Yakov
中科院分区：
文献类型：
--
作者：
Cohen, Steven P.;Hayek, Salim;Vorobeychik, Yakov
背景：颈神经根性疼痛是致残的主要原因。目前尚无研究对不同类型的非手术治疗进行比较。方法：对169例病程小于4年的神经根性颈痛患者进行疗效比较研究。参与者接受去甲替林和/或加巴喷丁加物理治疗，最多三次颈部硬膜外类固醇注射(ESI)，或在6个月内接受联合治疗。结果：1个月的臂痛评分，联合组为3.5(95%CI，2.8~4.2)，ESI组为4.2(CI，2.8~4.2)，保守治疗组为4.3(CI，2.8~4.2)(P=0.26)。1个月时，联合组患者平均手臂疼痛减少-3.1%(95%CI，-3.8%~-2.3%)，保守组为-1.8CI(-2.5%~-1.2%)，ESI组为-2.0CI(-2.7%~-1.3%，P=0.035)。在颈部疼痛方面，联合组平均减少-2.2(95%CI，-3.0至-1.5)，而保守组为-1.2(CI，-1.9至-0.5)，接受电喷组为-1.1(CI，-1.8至-0.4)；P=0.064)。治疗3个月后，56.9%的患者接受联合治疗，转归为阳性，保守组为26.8%，ESI患者为36.7%(P=0.006)。结论：尽管联合治疗在某些指标上比单独治疗有更好的改善，但在主要结果指标上，不同治疗方法之间没有显著差异。虽然这些结果表明，跨学科的方法治疗颈部疼痛可能会改善结果，但需要进行验证性研究。
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.