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Is Epidural Injection of Sodium Chloride Solution a True Placebo or an Active Control Agent? A Systematic Review and
Laxmaiah Manchikanti1, Nebojsa Nick Knezevic2, Jaya Sanapati3
1Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.
Pain Physician
|January 5, 2021
Summary
Epidural saline and steroids with saline effectively manage spinal pain, challenging the notion of saline as a true placebo. Both interventions demonstrate efficacy beyond placebo effects.
Area of Science:
- Pain Management
- Neurosurgery
- Anesthesiology
Background:
- Epidural injections and steroid use for spinal pain have a long history.
- Existing research on epidural saline and steroids yields conflicting results.
- True placebo-controlled trials are lacking, hindering definitive conclusions.
Purpose of the Study:
- Assess if epidural sodium chloride solution acts as a true placebo.
- Determine the efficacy of epidural saline alone for spinal pain.
- Evaluate the effectiveness of steroids when combined with saline for spinal pain.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) on epidural saline and/or steroids.
- Quality appraisal using IPM-QRB and evidence synthesis principles.
- Meta-analysis (dual-arm and single-arm) of pain and disability scores.
Main Results:
- No significant difference between epidural saline and steroids with saline in dual-arm meta-analysis.
- Single-arm analysis showed both interventions reduced pain by 20% but disability by only 10-12%.
- Qualitative analysis indicated both interventions are effective and not placebos, with strong evidence.
Conclusions:
- Epidural sodium chloride solution is not a true placebo.
- Epidural saline and steroids with saline may effectively manage low back and lower extremity pain.
- Further research is recommended due to suboptimal evidence quality.
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