Table 1.

Randomized controlledtrials testing different approaches.

Author	Journal and year of publication	Type of study	Total number of patient	Study groups	Key finding(s)
Haimovic and Beresford	Neurology 1986	Prospective, double-blind	33	Dexamethasone (oral) vs. placebo	Dexamethasone is not superior to placebo for treating sciatica
Holve and Barkan	JABFM 2008	Double-blind, controlled	27	Prednisone (oral) vs. placebo	Oral steroid medication in patients with sciatica had no significant effect on most parameters studied
Candido et al.	Pain Physician 2013	Prospective, randomized, blinded study.	106	ILESI midline vs. PSILESI (epidural)	PSILESI was more effective in targeting low back pain with unilateral radicular pain secondary to degenerative lumbar disc disease. Pressure paresthesia occurring ipsilaterally correlates with pain relief and may therefore be used as a prognostic factor
Spijker-Huiges et al.	BMC Musculoskeletal Disorders 2014	Pragmatic, single-blinded, randomized controlled trial	63	Care as usual vs. epidural steroid injection	Patients from the intervention group were significantly more satisfied with the received treatment. Positive effect of SESIs on back pain, impairment and disability in acute LRS
Kennedy et al.	Pain Medicine 2014	Prospective, randomized, double-blind trial	78	Dexamethasone vs. triamcinolone (TFESI) (epidural)	Dexamethasone appears to possess reasonably similar effectiveness when compared with triamcinolone. However, the dexamethasone group received slightly more injections than the triamcinolone group to achieve the same outcomes
Spijker-Huiges et al.	Archives of Physical Medicine and Rehabilitation 2015	Pragmatic randomized controlled trial	50	Care as usual vs. epidural steroid injection	Both groups show improvement in physical domains (SF-36): Intervention group scored better than control group. Cost-effectiveness acceptability curve implies that utility of adding ESI to usual care is cost-effective at 80% without additional investment
Manchikanti et al.	International Journal of Medical Sciences 2015	Two randomized controlled trials	240	Local anesthetic vs. local anesthetic with a steroid (epidural)	The group with local anesthetic alone achieved significant pain relief and functional status improvement with a lumbar interlaminar and caudal approach in 72 and 54%, respectively. The group receiving a combination of local anesthetic and steroid had a significant response rate with lumbar interlaminar and caudal approach in 67 and 68%, respectively. This analysis demonstrated that epidural injections with local anesthetic using lumbar interlaminar approach in the management of chronic low back pain, after excluding facet joint and SI joint pain, may be superior over a caudal approach
Singla et al.	Pain Practice 2017	Prospective randomized open blinded end point (PROBE) study	40	Lidocaine and methylprednisolone vs. leukocyte-free PRP and calcium chloride (intra-articular sacroiliac joint injection)	Compared to patients taking steroids, pain intensity was significantly lower among patients taking PRP at 6 weeks and 3 months. In addition, the efficacy of steroid injection at 3 months was reduced in steroid group and PRP group by 25 and 90%, respectively. When other factors were controlled, patients receiving PRP showed a reduction of VAS ≥ 50% from baseline. Patients receiving steroids had SF-12 and MODQ scores improved for up to 4 weeks, but then declined at 3 months, whereas the scores in patients taking PRP improved up to 3 months

ESI, epidural steroid injection; ILESI, interlaminar epidural steroid injection; LRS, lumbosacral radicular syndrome; MODQ, Modified Oswestry Disability Questionnaire; PRP, platelet-rich plasma; PSILESI, parasagittal interlaminar epidural steroid injection; SESIs, segmental epidural steroid injections; SF-36, 36-item short form survey; TFESI, transforaminal epidural steroid injection; VAS, visual analog scale.