Radiculopathy and radiating low back pain in general practice

Lumbosacral radicular syndrome (LRS) is a painful and impairing condition, for which few evidence-based pain treatments are known. The pain syndrome is mostly self-limiting, but the pain and impairment caused by the condition are often too intense for patients to ‘wait out’ the favourable natural prognosis. Since an inflammatory response around the nerve root is largely responsible for the complaints in LRS, an injection with corticosteroids might be of use. Corticosteroids are powerful anti-inflammatory medicines after all. In our study, we compared two patient groups. One group received the usual general practice care, the other the usual general practice care plus a corticosteroid injection. Both groups were followed for one year using postal questionnaires regarding pain, disability, quality of life and costs. From the results we learned that the intervention group experienced significantly less pain and disability than the control group. These differences remained constant during the entire study period, but were small: smaller than the pre-set threshold for clinical relevance. Clinical relevance is the magnitude of benefit a patient experiences with a certain amount of improvement. The intervention group also generated less costs than the control group. In conclusion, we advise to be cautious about implementing an invasive procedure with a small beneficial effect for patients, even if it will save healthcare costs.

Dissertation: http://irs.ub.rug.nl/ppn/387638865