Other outcome measures were functional improvement, improvement of psychological status, and return to work. Subgroup analyses were performed among trials with different control groups, with different techniques of epidural injections (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term).OUTCOME MEASURES: The primary outcome measure is pain relief. Three reviewers independently assessed the trials for the quality of their methods. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain.OBJECTIVE: To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions.STUDY DESIGN: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used.METHODS: Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. BACKGROUND: Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain.
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