Comparison of epidural injections and gabapentin for treating lumbosacral nerve root pain syndromes

What the study compared

On 16 April 2015, BMJ published a study by Cohen and colleagues involving 145 patients with lumbosacral nerve root pain at eight hospitals. One group received epidural steroid and placebo tablets; the other received gabapentin and a sham injection. There was no separate placebo-only group.^[1]

The study assessed two non-surgical treatments. Endoscopic surgery is considered separately, based on symptoms, examination and imaging.

What was found at one and three months

The primary outcome was average leg pain: no significant between-group difference was found at one or three months. At one month, the injection performed better on some secondary outcomes; at three months, no differences were found.^[1]

The absence of a significant difference also does not prove that the methods are equivalent or equally appropriate for every patient.

What matters today

NICE does not recommend gabapentinoids, including gabapentin, for sciatica because there is no overall evidence of benefit and there is a risk of harm. Epidural local anaesthetic with steroid may be considered for acute, severe sciatica. This is not a recommendation to give injections for every type of lower back pain.^[2]

If you already take gabapentin, do not stop it abruptly. Discuss the indication, response and next steps with your doctor. If stopping is necessary, the dose-reduction schedule is determined individually.^[3]

An epidural injection with needle-position guidance

Fluoroscopy using a C-arm is recommended for epidural access. Checking needle position and using contrast help verify where the injected solution spreads. A targeted procedure has a confirmed target; it is not simply an injection into a painful area of the back.^[4]

At the consultation, we clarify the level and side of symptoms, the procedure's aim, previous treatment and how the response will be assessed. More information: spinal injections and nerve blocks.

When we discuss endoscopic surgery

Injections and medication target symptoms. If nerve compression matches the symptoms and non-surgical treatment has not improved pain or function, decompression may be discussed.^[2]

My specialisation is endoscopic spine surgery. During a consultation, we compare symptoms, examination and images, identify the compressed area and determine the extent of surgery needed. The aim is a clear plan that addresses the cause of your symptoms.

Endoscopic removal of a lumbar disc herniation · Endoscopic decompression for lumbar stenosis

What to send for assessment of your case

• Symptoms: where the pain travels, how long it has lasted and what has changed in walking, sleep and work.
• Existing investigations: complete MRI/CT studies in DICOM format, reports and discharge summaries. New investigations are arranged after clarifying the need.
• Previous treatment: a medication list, previous injections and operations, their effects and how long relief lasted.
• Questions for the professor: what has been recommended and what outcome you would like to discuss.

Step by step: how to send CT/MRI scans in DICOM format