Homepage | Anesthesiologie.nl
Lumbosacral radicular painDescriptionStrength of recommendationLevel of evidenceEpidural corticosteroid administration could be used for the treatment of sub-acute lumbosacral radicular pain. Weak moderateDescriptionStrength of recommendationLevel of evidenceEpidural Tumor Necrosis Factor alpha (TNF – α) inhibitors administration could not be used for the management of lumbosacral radicular painWeak againstLowDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment adjacent to the lumbar ganglion spinale (dorsal root ganglion (DRG)) should not be used for the management of lumbosacral radicular pain.moderate againstmoderateDescriptionStrength of recommendationLevel of evidencePulsed radiofrequency could be considered in patients with chronic lumbosacral radicular pain. ModerateModerateClinical questionWhat is the place of interventional treatments in the management algorithm of lumbosacral radicular pain.Researched treatment optionsFor patients with lumbosacral radicular pain we studied the following treatments:Epidural corticosteroid administrationEpidural transforaminal anti TNF alpha administrationRadiofrequency treatment of the lumbar ggl spinale (DRG)Pulsed radiofrequency treatment of the lumbar ggl spinale (DRG)Any comparators including sham, no treatment or other active treatment techniques were eligible. Inclusion was not restricted based on outcome.Methods For the search strategy we refer to the special section on methods of these guidelines.Interlaminar and transforaminal epidural corticosteroid administration Literature overview:Since the previous guideline, ADDIN EN.CITE <EndNote><Cite><Author>Van Boxem</Author><Year>2010</Year><RecNum>5517</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>5517</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5517</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Van Boxem, K.</author><author>Cheng, J.</author><author>Patijn, J.</author><author>van Kleef, M.</author><author>Lataster, A.</author><author>Mekhail, N.</author><author>Van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.</auth-address><titles><title>11. Lumbosacral radicular pain</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>339-58</pages><volume>10</volume><number>4</number><edition>2010/05/25</edition><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1533-2500 (Electronic)
1530-7085 (Linking)</isbn><accession-num>20492580</accession-num><urls><related-urls><url> [pii]
10.1111/j.1533-2500.2010.00370.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 a number of systematic reviews have been published in relation to epidural injections for lumbosacral radicular pain. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXdpczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXdpczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl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ADDIN EN.CITE.DATA 2-17 The reviews have evaluated epidural injections without distinction between types of injection or have investigated either transforaminal or interlaminar administration of corticosteroids or have compared the two methods. It was decided to base the results for these two interventions on the review of evidence conducted by Shamliyan PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFtbGl5YW48L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy
PjxSZWNOdW0+MTIwODM8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2Ny
aXB0Ij4xODwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEyMDgzPC9y
ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idmVyMnB3ZWV5ZjBk
ZjJlcnZ4aHYweHMxdjJ6OXgyeng1MnNyIiB0aW1lc3RhbXA9IjE0NzQwNDIzMDIiPjEyMDgzPC9r
ZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3Jl
Zi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TaGFtbGl5YW4sIFQuIEEuPC9h
dXRob3I+PGF1dGhvcj5TdGFhbCwgSi4gQi48L2F1dGhvcj48YXV0aG9yPkdvbGRtYW5uLCBELjwv
YXV0aG9yPjxhdXRob3I+U2FuZHMtTGluY29sbiwgTS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250
cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5FbHNldmllciBDbGluaWNhbCBTb2x1dGlvbnMsIEV2aWRl
bmNlLUJhc2VkIE1lZGljaW5lIENlbnRlciwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLiBFbGVjdHJv
bmljIGFkZHJlc3M6IHQuc2hhbWxpeWFuQGVsc2V2aWVyLmNvbS4mI3hEO1NjaWVudGlmaWMgSW5z
dGl0dXRlIGZvciBRdWFsaXR5IG9mIEhlYWx0aGNhcmUgKElRIEhlYWx0aGNhcmUpLCBSYWRib3Vk
IFVuaXZlcnNpdHkgTmlqbWVnZW4gTWVkaWNhbCBDZW50cmUsIE5pam1lZ2VuLCBUaGUgTmV0aGVy
bGFuZHMuJiN4RDtFbHNldmllciBDbGluaWNhbCBTb2x1dGlvbnMsIEV2aWRlbmNlLUJhc2VkIE1l
ZGljaW5lIENlbnRlciwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRs
ZXM+PHRpdGxlPkVwaWR1cmFsIHN0ZXJvaWQgaW5qZWN0aW9ucyBmb3IgcmFkaWN1bGFyIGx1bWJv
c2FjcmFsIHBhaW46IGEgc3lzdGVtYXRpYyByZXZpZXc8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+
UGh5cyBNZWQgUmVoYWJpbCBDbGluIE4gQW08L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5QaHlzIE1lZCBSZWhhYmlsIENsaW4gTiBBbTwvZnVsbC10aXRs
ZT48L3BlcmlvZGljYWw+PHBhZ2VzPjQ3MS04OSBlMS01MDwvcGFnZXM+PHZvbHVtZT4yNTwvdm9s
dW1lPjxudW1iZXI+MjwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BZHJlbmFsIENvcnRleCBI
b3Jtb25lcy8qYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlL2FkdmVyc2UgZWZmZWN0czwva2V5
d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3
b3JkPkRpc2FiaWxpdHkgRXZhbHVhdGlvbjwva2V5d29yZD48a2V5d29yZD5Eb3NlLVJlc3BvbnNl
IFJlbGF0aW9uc2hpcCwgRHJ1Zzwva2V5d29yZD48a2V5d29yZD5FdmlkZW5jZS1CYXNlZCBNZWRp
Y2luZTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Rm9sbG93LVVw
IFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkluY2lk
ZW5jZTwva2V5d29yZD48a2V5d29yZD5JbmplY3Rpb25zLCBFcGlkdXJhbDwva2V5d29yZD48a2V5
d29yZD5Mb3cgQmFjayBQYWluL2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L2VwaWRlbWlvbG9neTwv
a2V5d29yZD48a2V5d29yZD5MdW1ib3NhY3JhbCBSZWdpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFs
ZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5QYWluIE1h
bmFnZW1lbnQvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UGFpbiBNZWFzdXJlbWVudDwva2V5
d29yZD48a2V5d29yZD5SYWRpY3Vsb3BhdGh5L2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L2VwaWRl
bWlvbG9neTwva2V5d29yZD48a2V5d29yZD5SaXNrIEFzc2Vzc21lbnQ8L2tleXdvcmQ+PGtleXdv
cmQ+U2V2ZXJpdHkgb2YgSWxsbmVzcyBJbmRleDwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQg
T3V0Y29tZTwva2V5d29yZD48a2V5d29yZD5Vbml0ZWQgU3RhdGVzL2VwaWRlbWlvbG9neTwva2V5
d29yZD48a2V5d29yZD5FcGlkdXJhbCBpbmplY3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+TG93IGJh
Y2sgcGFpbjwva2V5d29yZD48a2V5d29yZD5MdW1ib3NhY3JhbCByYWRpY3VsYXIgc3luZHJvbWU8
L2tleXdvcmQ+PGtleXdvcmQ+U3Rlcm9pZHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll
YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heTwvZGF0ZT48L3B1Yi1kYXRlcz48L2Rh
dGVzPjxpc2JuPjE1NTgtMTM4MSAoRWxlY3Ryb25pYykmI3hEOzEwNDctOTY1MSAoTGlua2luZyk8
L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ3ODczNDQ8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0
ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0Nzg3MzQ0
PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4x
MDE2L2oucG1yLjIwMTQuMDIuMDAxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48
L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFtbGl5YW48L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE.DATA 18. This is a systematic review of guidelines, systematic reviews, RCT’s and large observational cohort studies that report safety. This review found that, overall, epidural steroid injections provide short term but not long-term (over 12 weeks) relief of leg pain and improvement in function when compared with placebo but the clinical benefit is small. Transforaminal corticosteroids are better than placebo in reducing leg pain at long-term follow-up with no improvement in disability, based on very low quality evidence. No single specific injection technique improved back pain. The effect of a corticosteroid injection is not better than local anesthetic alone. There is insufficient evidence to link short-term effectiveness of steroid injections and differing patient characteristicsPinto et al. ADDIN EN.CITE <EndNote><Cite><Author>Pinto</Author><Year>2012</Year><RecNum>10258</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>10258</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1378807164">10258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pinto, R. Z.</author><author>Maher, C. G.</author><author>Ferreira, M. L.</author><author>Hancock, M.</author><author>Oliveira, V. C.</author><author>McLachlan, A. J.</author><author>Koes, B.</author><author>Ferreira, P. H.</author></authors></contributors><auth-address>The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia. rafaelzambelli@</auth-address><titles><title>Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis</title><secondary-title>Ann Intern Med</secondary-title></titles><periodical><full-title>Ann Intern Med</full-title></periodical><pages>865-77</pages><volume>157</volume><number>12</number><keywords><keyword>Adrenal Cortex Hormones/*administration & dosage/therapeutic use</keyword><keyword>Humans</keyword><keyword>Injections, Epidural</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Research Design</keyword><keyword>Sciatica/*drug therapy</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec 18</date></pub-dates></dates><accession-num>23362516</accession-num><urls><related-urls><url> reviewed only RCTs on the epidural administration of corticosteroids. They included 25 publications on 23 trials. The results were comparable to the results of Shamliyan PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFtbGl5YW48L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy
PjxSZWNOdW0+MTIwODM8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2Ny
aXB0Ij4xODwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEyMDgzPC9y
ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idmVyMnB3ZWV5ZjBk
ZjJlcnZ4aHYweHMxdjJ6OXgyeng1MnNyIiB0aW1lc3RhbXA9IjE0NzQwNDIzMDIiPjEyMDgzPC9r
ZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3Jl
Zi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TaGFtbGl5YW4sIFQuIEEuPC9h
dXRob3I+PGF1dGhvcj5TdGFhbCwgSi4gQi48L2F1dGhvcj48YXV0aG9yPkdvbGRtYW5uLCBELjwv
YXV0aG9yPjxhdXRob3I+U2FuZHMtTGluY29sbiwgTS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250
cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5FbHNldmllciBDbGluaWNhbCBTb2x1dGlvbnMsIEV2aWRl
bmNlLUJhc2VkIE1lZGljaW5lIENlbnRlciwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLiBFbGVjdHJv
bmljIGFkZHJlc3M6IHQuc2hhbWxpeWFuQGVsc2V2aWVyLmNvbS4mI3hEO1NjaWVudGlmaWMgSW5z
dGl0dXRlIGZvciBRdWFsaXR5IG9mIEhlYWx0aGNhcmUgKElRIEhlYWx0aGNhcmUpLCBSYWRib3Vk
IFVuaXZlcnNpdHkgTmlqbWVnZW4gTWVkaWNhbCBDZW50cmUsIE5pam1lZ2VuLCBUaGUgTmV0aGVy
bGFuZHMuJiN4RDtFbHNldmllciBDbGluaWNhbCBTb2x1dGlvbnMsIEV2aWRlbmNlLUJhc2VkIE1l
ZGljaW5lIENlbnRlciwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRs
ZXM+PHRpdGxlPkVwaWR1cmFsIHN0ZXJvaWQgaW5qZWN0aW9ucyBmb3IgcmFkaWN1bGFyIGx1bWJv
c2FjcmFsIHBhaW46IGEgc3lzdGVtYXRpYyByZXZpZXc8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+
UGh5cyBNZWQgUmVoYWJpbCBDbGluIE4gQW08L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5QaHlzIE1lZCBSZWhhYmlsIENsaW4gTiBBbTwvZnVsbC10aXRs
ZT48L3BlcmlvZGljYWw+PHBhZ2VzPjQ3MS04OSBlMS01MDwvcGFnZXM+PHZvbHVtZT4yNTwvdm9s
dW1lPjxudW1iZXI+MjwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BZHJlbmFsIENvcnRleCBI
b3Jtb25lcy8qYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlL2FkdmVyc2UgZWZmZWN0czwva2V5
d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3
b3JkPkRpc2FiaWxpdHkgRXZhbHVhdGlvbjwva2V5d29yZD48a2V5d29yZD5Eb3NlLVJlc3BvbnNl
IFJlbGF0aW9uc2hpcCwgRHJ1Zzwva2V5d29yZD48a2V5d29yZD5FdmlkZW5jZS1CYXNlZCBNZWRp
Y2luZTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Rm9sbG93LVVw
IFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkluY2lk
ZW5jZTwva2V5d29yZD48a2V5d29yZD5JbmplY3Rpb25zLCBFcGlkdXJhbDwva2V5d29yZD48a2V5
d29yZD5Mb3cgQmFjayBQYWluL2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L2VwaWRlbWlvbG9neTwv
a2V5d29yZD48a2V5d29yZD5MdW1ib3NhY3JhbCBSZWdpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFs
ZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5QYWluIE1h
bmFnZW1lbnQvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UGFpbiBNZWFzdXJlbWVudDwva2V5
d29yZD48a2V5d29yZD5SYWRpY3Vsb3BhdGh5L2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L2VwaWRl
bWlvbG9neTwva2V5d29yZD48a2V5d29yZD5SaXNrIEFzc2Vzc21lbnQ8L2tleXdvcmQ+PGtleXdv
cmQ+U2V2ZXJpdHkgb2YgSWxsbmVzcyBJbmRleDwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQg
T3V0Y29tZTwva2V5d29yZD48a2V5d29yZD5Vbml0ZWQgU3RhdGVzL2VwaWRlbWlvbG9neTwva2V5
d29yZD48a2V5d29yZD5FcGlkdXJhbCBpbmplY3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+TG93IGJh
Y2sgcGFpbjwva2V5d29yZD48a2V5d29yZD5MdW1ib3NhY3JhbCByYWRpY3VsYXIgc3luZHJvbWU8
L2tleXdvcmQ+PGtleXdvcmQ+U3Rlcm9pZHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll
YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heTwvZGF0ZT48L3B1Yi1kYXRlcz48L2Rh
dGVzPjxpc2JuPjE1NTgtMTM4MSAoRWxlY3Ryb25pYykmI3hEOzEwNDctOTY1MSAoTGlua2luZyk8
L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ3ODczNDQ8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0
ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0Nzg3MzQ0
PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4x
MDE2L2oucG1yLjIwMTQuMDIuMDAxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48
L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFtbGl5YW48L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE.DATA 18 although the Pinto group rated the quality of the evidence to be high. Conclusion: Short-term effectQuality of the evidence DescriptionModerateThere is evidence of moderate quality that epidural corticosteroid with or without local anesthetic administration reduces modestly leg pain better than placebo during 3 months after the intervention in the treatment of lumbosacral radicular pain refractory to conservative treatment Pinto RZ et al. 2012; Shamliyan et al. 2014Long-term effectQuality of the evidence DescriptionModerate There is evidence of moderate quality that epidural corticosteroid with or without local anesthetic administration does not reduce leg pain better than placebo/ local anesthetic during 12 months after the intervention in the treatment of lumbosacral radicular pain refractory to conservative treatment Shamliyan et al. 2014. Quality of the evidence DescriptionLow There is evidence of moderate quality that epidural corticosteroid with or without local anesthetic administration does not reduce disability better than placebo/ local anesthetic during 12 months after the intervention in the treatment of lumbosacral radicular pain refractory to conservative treatmentShamliyan et al. 2014ConsiderationsEvidence of alternative strategies for lumbosacral radicular painThe initial management of radicular pain is conservative because of the positive spontaneous pain reduction within 3 months in 75% of the patients. ADDIN EN.CITE <EndNote><Cite><Author>Peul</Author><Year>2008</Year><RecNum>4016</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>4016</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">4016</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Peul, W. C.</author><author>Brand, R.</author><author>Thomeer, R. T.</author><author>Koes, B. W.</author></authors></contributors><auth-address>Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. w.c.peul@lumc.nl</auth-address><titles><title>Influence of gender and other prognostic factors on outcome of sciatica</title><secondary-title>Pain</secondary-title></titles><periodical><full-title>Pain</full-title></periodical><pages>180-91</pages><volume>138</volume><number>1</number><edition>2008/02/05</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Netherlands/epidemiology</keyword><keyword>Outcome Assessment (Health Care)/*methods</keyword><keyword>Prevalence</keyword><keyword>Prognosis</keyword><keyword>Risk Assessment/*methods</keyword><keyword>Risk Factors</keyword><keyword>Sciatica/*diagnosis/*epidemiology</keyword><keyword>Sex Factors</keyword></keywords><dates><year>2008</year><pub-dates><date>Aug 15</date></pub-dates></dates><isbn>1872-6623 (Electronic)</isbn><accession-num>18241991</accession-num><urls><related-urls><url>(07)00747-6 [pii]
10.1016/j.pain.2007.12.014</electronic-resource-num><language>eng</language></record></Cite></EndNote>19 The evidence of bedrest, activation, physical therapy, exercises or medication (acetaminophen/paracetamol, NSAID, systemic glucocorticoids, anti epileptics, antidepressants, muscle relaxants, opioids) is limited or insufficient. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hb2xkYmVyZzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hb2xkYmVyZzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+
PFJlY051bT4xMTQ4MDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3Jp
cHQiPjIwLTIyPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTE0ODA8
L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ2ZXIycHdlZXlm
MGRmMmVydnhodjB4czF2Mno5eDJ6eDUyc3IiIHRpbWVzdGFtcD0iMTQzODI3ODUyMCI+MTE0ODA8
L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv
cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkdvbGRiZXJnLCBILjwvYXV0
aG9yPjxhdXRob3I+RmlydGNoLCBXLjwvYXV0aG9yPjxhdXRob3I+VHlidXJza2ksIE0uPC9hdXRo
b3I+PGF1dGhvcj5QcmVzc21hbiwgQS48L2F1dGhvcj48YXV0aG9yPkFja2Vyc29uLCBMLjwvYXV0
aG9yPjxhdXRob3I+SGFtaWx0b24sIEwuPC9hdXRob3I+PGF1dGhvcj5TbWl0aCwgVy48L2F1dGhv
cj48YXV0aG9yPkNhcnZlciwgUi48L2F1dGhvcj48YXV0aG9yPk1hcmF0dWt1bGFtLCBBLjwvYXV0
aG9yPjxhdXRob3I+V29uLCBMLiBBLjwvYXV0aG9yPjxhdXRob3I+Q2FycmFnZWUsIEUuPC9hdXRo
b3I+PGF1dGhvcj5BdmlucywgQS4gTC48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+
PGF1dGgtYWRkcmVzcz5LYWlzZXIgUGVybWFuZW50ZSBOb3J0aGVybiBDYWxpZm9ybmlhIFNwaW5l
IENhcmUgUHJvZ3JhbSwgU2FuIEpvc2UyRGl2aXNpb24gb2YgUmVzZWFyY2gsIEthaXNlciBQZXJt
YW5lbnRlIE5vcnRoZXJuIENhbGlmb3JuaWEsIE9ha2xhbmQuJiN4RDtLYWlzZXIgUGVybWFuZW50
ZSBOb3J0aGVybiBDYWxpZm9ybmlhIFNwaW5lIENhcmUgUHJvZ3JhbSwgUmVkd29vZCBDaXR5LiYj
eEQ7S2Fpc2VyIFBlcm1hbmVudGUgTm9ydGhlcm4gQ2FsaWZvcm5pYSBTcGluZSBDYXJlIFByb2dy
YW0sIFJvc2V2aWxsZS4mI3hEO0RpdmlzaW9uIG9mIFJlc2VhcmNoLCBLYWlzZXIgUGVybWFuZW50
ZSBOb3J0aGVybiBDYWxpZm9ybmlhLCBPYWtsYW5kNVN1dHRlciBIZWFsdGggUmVzZWFyY2gsIERl
dmVsb3BtZW50LCBhbmQgRGlzc2VtaW5hdGlvbiwgV2FsbnV0IENyZWVrLCBDYWxpZm9ybmlhLiYj
eEQ7RGl2aXNpb24gb2YgUmVzZWFyY2gsIEthaXNlciBQZXJtYW5lbnRlIE5vcnRoZXJuIENhbGlm
b3JuaWEsIE9ha2xhbmQuJiN4RDtLYWlzZXIgUGVybWFuZW50ZSBOb3J0aGVybiBDYWxpZm9ybmlh
IFNwaW5lIENhcmUgUHJvZ3JhbSwgU2FuIEpvc2UuJiN4RDtPcnRob3BlZGljIFNwaW5lIFN1cmdl
cnkgRGl2aXNpb24sIERlcGFydG1lbnQgb2YgT3J0aG9wZWRpY3MsIFN0YW5mb3JkIFVuaXZlcnNp
dHksIFBhbG8gQWx0bywgQ2FsaWZvcm5pYS4mI3hEO0RpdmlzaW9uIG9mIFJlc2VhcmNoLCBLYWlz
ZXIgUGVybWFuZW50ZSBOb3J0aGVybiBDYWxpZm9ybmlhLCBPYWtsYW5kN0RlcGFydG1lbnQgb2Yg
TWVkaWNpbmUsIFVuaXZlcnNpdHkgb2YgQ2FsaWZvcm5pYSwgU2FuIEZyYW5jaXNjbzhEZXBhcnRt
ZW50IG9mIEVwaWRlbWlvbG9neSBhbmQgQmlvc3RhdGlzdGljcywgVW5pdmVyc2l0eSBvZiBDYWxp
Zm9ybmlhLCBTYW4gRnJhbmNpc2NvLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPk9yYWwg
c3Rlcm9pZHMgZm9yIGFjdXRlIHJhZGljdWxvcGF0aHkgZHVlIHRvIGEgaGVybmlhdGVkIGx1bWJh
ciBkaXNrOiBhIHJhbmRvbWl6ZWQgY2xpbmljYWwgdHJpYWw8L3RpdGxlPjxzZWNvbmRhcnktdGl0
bGU+SkFNQTwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxl
PkphbWE8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xOTE1LTIzPC9wYWdlcz48dm9s
dW1lPjMxMzwvdm9sdW1lPjxudW1iZXI+MTk8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWN1
dGUgRGlzZWFzZTwva2V5d29yZD48a2V5d29yZD5BZG1pbmlzdHJhdGlvbiwgT3JhbDwva2V5d29y
ZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3Jk
PkRvdWJsZS1CbGluZCBNZXRob2Q8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxr
ZXl3b3JkPkZvbGxvdy1VcCBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPkdsdWNvY29ydGljb2lk
cy9hZHZlcnNlIGVmZmVjdHMvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5IdW1h
bnM8L2tleXdvcmQ+PGtleXdvcmQ+SW50ZXJ2ZXJ0ZWJyYWwgRGlzYyBEaXNwbGFjZW1lbnQvKmNv
bXBsaWNhdGlvbnM8L2tleXdvcmQ+PGtleXdvcmQ+Kkx1bWJhciBWZXJ0ZWJyYWU8L2tleXdvcmQ+
PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5
d29yZD5QYWluIE1lYXN1cmVtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlByZWRuaXNvbmUvYWR2ZXJz
ZSBlZmZlY3RzLyp0aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+UmFkaWN1bG9wYXRo
eS8qZHJ1ZyB0aGVyYXB5L2V0aW9sb2d5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFy
PjIwMTU8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXkgMTk8L2RhdGU+PC9wdWItZGF0ZXM+PC9k
YXRlcz48aXNibj4xNTM4LTM1OTggKEVsZWN0cm9uaWMpJiN4RDswMDk4LTc0ODQgKExpbmtpbmcp
PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI1OTg4NDYxPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxh
dGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI1OTg4NDYx
PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4x
MDAxL2phbWEuMjAxNS40NDY4PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0Np
dGU+PENpdGU+PEF1dGhvcj5EYWhtPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVjTnVtPjEx
NDgxPC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4xMTQ4MTwvcmVjLW51bWJlcj48Zm9yZWln
bi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InZlcjJwd2VleWYwZGYyZXJ2eGh2MHhzMXYyejl4
Mnp4NTJzciIgdGltZXN0YW1wPSIxNDM4Mjc4NTk5Ij4xMTQ4MTwva2V5PjwvZm9yZWlnbi1rZXlz
PjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0
b3JzPjxhdXRob3JzPjxhdXRob3I+RGFobSwgSy4gVC48L2F1dGhvcj48YXV0aG9yPkJydXJiZXJn
LCBLLiBHLjwvYXV0aG9yPjxhdXRob3I+SmFtdHZlZHQsIEcuPC9hdXRob3I+PGF1dGhvcj5IYWdl
biwgSy4gQi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5O
b3J3ZWdpYW4gS25vd2xlZGdlIENlbnRyZSBmb3IgdGhlIEhlYWx0aCBTZXJ2aWNlcywgUE8gQm94
IDcwMDQsIFN0LiBPbGF2cyBQbGFzcywgT3NsbywgTm9yd2F5LCBOLTAxMzAuPC9hdXRoLWFkZHJl
c3M+PHRpdGxlcz48dGl0bGU+QWR2aWNlIHRvIHJlc3QgaW4gYmVkIHZlcnN1cyBhZHZpY2UgdG8g
c3RheSBhY3RpdmUgZm9yIGFjdXRlIGxvdy1iYWNrIHBhaW4gYW5kIHNjaWF0aWNhPC90aXRsZT48
c2Vjb25kYXJ5LXRpdGxlPkNvY2hyYW5lIERhdGFiYXNlIFN5c3QgUmV2PC9zZWNvbmRhcnktdGl0
bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q29jaHJhbmUgRGF0YWJhc2UgU3lz
dCBSZXY8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz5DRDAwNzYxMjwvcGFnZXM+PG51
bWJlcj42PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPipCZWQgUmVzdDwva2V5d29yZD48a2V5
d29yZD4qRXhlcmNpc2U8L2tleXdvcmQ+PGtleXdvcmQ+KkV4ZXJjaXNlIFRoZXJhcHk8L2tleXdv
cmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkxvdyBCYWNrIFBhaW4vKnJlaGFi
aWxpdGF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPlBhdGllbnQgRWR1Y2F0aW9uIGFzIFRvcGljPC9r
ZXl3b3JkPjxrZXl3b3JkPlJhbmRvbWl6ZWQgQ29udHJvbGxlZCBUcmlhbHMgYXMgVG9waWM8L2tl
eXdvcmQ+PGtleXdvcmQ+U2NpYXRpY2EvKnJlaGFiaWxpdGF0aW9uPC9rZXl3b3JkPjwva2V5d29y
ZHM+PGRhdGVzPjx5ZWFyPjIwMTA8L3llYXI+PC9kYXRlcz48aXNibj4xNDY5LTQ5M1ggKEVsZWN0
cm9uaWMpJiN4RDsxMzYxLTYxMzcgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIwNTU2
NzgwPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5j
YmkubmxtLm5paC5nb3YvcHVibWVkLzIwNTU2NzgwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxz
PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDAyLzE0NjUxODU4LkNEMDA3NjEyLnB1YjI8
L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPkRl
eW88L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNOdW0+MTE5OTk8L1JlY051bT48cmVjb3Jk
PjxyZWMtbnVtYmVyPjExOTk5PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVO
IiBkYi1pZD0idmVyMnB3ZWV5ZjBkZjJlcnZ4aHYweHMxdjJ6OXgyeng1MnNyIiB0aW1lc3RhbXA9
IjE0NzAzMzMxOTEiPjExOTk5PC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9Ikpv
dXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhv
cj5EZXlvLCBSLiBBLjwvYXV0aG9yPjxhdXRob3I+TWlyemEsIFMuIEsuPC9hdXRob3I+PC9hdXRo
b3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RnJvbSB0aGUgRGVwYXJ0bWVudHMgb2Yg
RmFtaWx5IE1lZGljaW5lLCBNZWRpY2luZSwgYW5kIFB1YmxpYyBIZWFsdGggYW5kIFByZXZlbnRp
dmUgTWVkaWNpbmUsIGFuZCB0aGUgT3JlZ29uIEluc3RpdHV0ZSBvZiBPY2N1cGF0aW9uYWwgSGVh
bHRoIFNjaWVuY2VzLCBPcmVnb24gSGVhbHRoIGFuZCBTY2llbmNlIFVuaXZlcnNpdHksIFBvcnRs
YW5kIChSLkEuRC4pOyBhbmQgdGhlIERlcGFydG1lbnQgb2YgT3J0aG9wYWVkaWMgU3VyZ2VyeSBh
bmQgdGhlIERhcnRtb3V0aCBJbnN0aXR1dGUsIERhcnRtb3V0aCBHZWlzZWwgU2Nob29sIG9mIE1l
ZGljaW5lLCBIYW5vdmVyLCBOSCAoUy5LLk0uKS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs
ZT5DTElOSUNBTCBQUkFDVElDRS4gSGVybmlhdGVkIEx1bWJhciBJbnRlcnZlcnRlYnJhbCBEaXNr
PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk4gRW5nbCBKIE1lZDwvc2Vjb25kYXJ5LXRpdGxlPjwv
dGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk4gRW5nbCBKIE1lZDwvZnVsbC10aXRsZT48
L3BlcmlvZGljYWw+PHBhZ2VzPjE3NjMtNzI8L3BhZ2VzPjx2b2x1bWU+Mzc0PC92b2x1bWU+PG51
bWJlcj4xODwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29y
ZD5BbmFsZ2VzaWNzL3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl
eXdvcmQ+PGtleXdvcmQ+SW50ZXJ2ZXJ0ZWJyYWwgRGlzYyBEaXNwbGFjZW1lbnQvZGlhZ25vc2lz
LypzdXJnZXJ5Lyp0aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPkxvdyBCYWNrIFBhaW4vZXRpb2xv
Z3k8L2tleXdvcmQ+PGtleXdvcmQ+Kkx1bWJhciBWZXJ0ZWJyYWUvc3VyZ2VyeTwva2V5d29yZD48
a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbmlwdWxhdGlvbiwgQ2hpcm9wcmFjdGlj
PC9rZXl3b3JkPjxrZXl3b3JkPipQaHlzaWNhbCBUaGVyYXB5IE1vZGFsaXRpZXM8L2tleXdvcmQ+
PGtleXdvcmQ+U2NpYXRpY2EvZXRpb2xvZ3kvdGhlcmFweTwva2V5d29yZD48L2tleXdvcmRzPjxk
YXRlcz48eWVhcj4yMDE2PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+TWF5IDU8L2RhdGU+PC9wdWIt
ZGF0ZXM+PC9kYXRlcz48aXNibj4xNTMzLTQ0MDYgKEVsZWN0cm9uaWMpJiN4RDswMDI4LTQ3OTMg
KExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI3MTQ0ODUxPC9hY2Nlc3Npb24tbnVtPjx1
cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVk
LzI3MTQ0ODUxPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNl
LW51bT4xMC4xMDU2L05FSk1jcDE1MTI2NTg8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVj
b3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE.DATA 20-22 Position of epidural corticosteroids in treatment algorithmIf after several weeks of conservative treatment patients still report high pain scores, two strategies are valid : immediately proceed to surgery, or try to “bridge” the first 3 months until the chance of spontaneous resolution of symptoms becomes very small. The main indications for epidural corticosteroids are therefore : persistent pain despite conservative management during the first weeks to months, when there is no surgical indication or patient refusal of surgery. The administration of epidural corticosteroids is cost-effectivePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TcGlqa2VyLUh1aWdlczwvQXV0aG9yPjxZZWFyPjIwMTQ8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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TcGlqa2VyLUh1aWdlczwvQXV0aG9yPjxZZWFyPjIwMTQ8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ADDIN EN.CITE.DATA 23 , making a “stepped-up approach” with epidural steroid injections before proceeding to surgery the most cost-effective in a health economic model.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXR6c2ltbW9uczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXR6c2ltbW9uczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1ll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ADDIN EN.CITE.DATA 24 The majority of the studies and reviews make no difference between (sub)-acute and chronic lumbosacral radicular pain, therefore the restriction to reserve epidural injection for sub-acute lumbosacral radicular pain cannot be supported by evidence from clinical trials. The short duration of action and limited clinical relevant improvement, allows patients in the sub-acute phase to exercise and thus stimulates the natural recovery.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj52YW4gSGVsdm9pcnQ8L0F1dGhvcj48WWVhcj4yMDE0PC9Z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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj52YW4gSGVsdm9pcnQ8L0F1dGhvcj48WWVhcj4yMDE0PC9Z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ADDIN EN.CITE.DATA 25 For patients with chronic lumbosacral radicular pain the treatment would have to be frequently repeated, thus increasing the risk for side effects and complication. Therefore other treatment options are preferred in the chronic phase.In clinical trials corticosteroids are often mixed with local anesthetic, making it difficult to judge the clinical relevance of adding local anesthetic to the injectate. Risk of contamination and serious infectionsThe “Division of Pharmacovigilance II” of the FDA evaluated the incidence of serious neurological complications after the administration of epidural corticosteroids, through the “FDA Adverse Event Reporting System” (FAERS) database. A search included articles from 1 January 1965 until 04/23/2014 regarding arachnoiditis, and from 11/1/1997 tot 04/23/2014 for serious complications of the nervous system “nervous system disorder”. This resulted in 131 cases in total (18 published case reports included), of which 41 cases of arachnoiditis and 90 serious cases of “nervous system disorder”. ADDIN EN.CITE <EndNote><Cite><Author>FDA</Author><Year>2014</Year><RecNum>11544</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>11544</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1442409418">11544</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>FDA ,</author></authors><secondary-authors><author>Anesthetic and Analgesic Drug Products Advisory Committee,</author></secondary-authors></contributors><titles><title>Epidural Steroid Injections (ESI) and the Risk of Serious Neurologic Adverse Reactions</title><secondary-title>Anesthetic and Analgesic Drug Products Advisory Committee: Briefing document</secondary-title></titles><dates><year>2014</year><pub-dates><date>November 24-25</date></pub-dates></dates><urls><related-urls><url>AdvisoryCommittees/ CommitteesMeetingMaterials/Drugs/ AnastheticAndAnalegicDrugProductsAdvisory Committee/ucm422691.htm </url></related-urls></urls></record></Cite></EndNote>26 Cases of fungal contamination were not included. An exact incidence can not be determined, for this demands an extensive population based study PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE.DATA 27, but only in the U.S. there are estimations that up to 9 miljons epidural corticosteroid infiltrations are done on a yearly base. It is clearly stated that major complications are rare , making it impossible to determine the exact incidence of complications. ADDIN EN.CITE <EndNote><Cite><Author>FDA</Author><Year>2014</Year><RecNum>11544</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>11544</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1442409418">11544</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>FDA ,</author></authors><secondary-authors><author>Anesthetic and Analgesic Drug Products Advisory Committee,</author></secondary-authors></contributors><titles><title>Epidural Steroid Injections (ESI) and the Risk of Serious Neurologic Adverse Reactions</title><secondary-title>Anesthetic and Analgesic Drug Products Advisory Committee: Briefing document</secondary-title></titles><dates><year>2014</year><pub-dates><date>November 24-25</date></pub-dates></dates><urls><related-urls><url>AdvisoryCommittees/ CommitteesMeetingMaterials/Drugs/ AnastheticAndAnalegicDrugProductsAdvisory Committee/ucm422691.htm </url></related-urls></urls></record></Cite></EndNote>26 PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE.DATA 27 ADDIN EN.CITE <EndNote><Cite><Author>McGrath</Author><Year>2011</Year><RecNum>11450</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>11450</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1436793130">11450</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McGrath, J. M.</author><author>Schaefer, M. P.</author><author>Malkamaki, D. M.</author></authors></contributors><auth-address>MetroHealth Campus of Case Western Reserve University School of Medicine, Cleveland Heights, Ohio , USA.</auth-address><titles><title>Incidence and characteristics of complications from epidural steroid injections</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>Pain Med</full-title></periodical><pages>726-31</pages><volume>12</volume><number>5</number><keywords><keyword>Back Pain/drug therapy</keyword><keyword>Cervical Vertebrae</keyword><keyword>Humans</keyword><keyword>Injections, Epidural/*adverse effects</keyword><keyword>Lumbar Vertebrae</keyword><keyword>Radiculopathy/drug therapy</keyword><keyword>Retrospective Studies</keyword><keyword>Steroids/*administration & dosage/*adverse effects/therapeutic use</keyword></keywords><dates><year>2011</year><pub-dates><date>May</date></pub-dates></dates><isbn>1526-4637 (Electronic)
1526-2375 (Linking)</isbn><accession-num>21392252</accession-num><urls><related-urls><url> In summary, there seems to be a limited clinical effect in the short-term for epidural corticosteroid injections for the treatment of (sub)-acute lumbosacral radicular pain. Severe side effects have rarely been reported.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWNvb3NpbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE.DATA 27 This treatment is an “off label” use of corticosteroids, therefore written informed consent is mandatory. The use of image guidance is obligatory for safety reasons. Epidural corticosteroid administration is a low cost treatment. The three administration routes have been compared by Cohen. ADDIN EN.CITE <EndNote><Cite><Author>Cohen</Author><Year>2013</Year><RecNum>10400</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>10400</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1387205059">10400</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cohen, S. P.</author><author>Bicket, M. C.</author><author>Jamison, D.</author><author>Wilkinson, I.</author><author>Rathmell, J. P.</author></authors></contributors><auth-address>Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. scohen40@jhmi.edu</auth-address><titles><title>Epidural steroids: a comprehensive, evidence-based review</title><secondary-title>Reg Anesth Pain Med</secondary-title></titles><periodical><full-title>Reg Anesth Pain Med</full-title></periodical><pages>175-200</pages><volume>38</volume><number>3</number><keywords><keyword>Adrenal Cortex Hormones/*administration & dosage/adverse effects</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Health Services/utilization</keyword><keyword>Humans</keyword><keyword>Injections, Epidural/adverse effects</keyword><keyword>Low Back Pain/drug therapy</keyword><keyword>Neck Pain/drug therapy</keyword><keyword>Pain/*drug therapy</keyword></keywords><dates><year>2013</year><pub-dates><date>May-Jun</date></pub-dates></dates><accession-num>23598728</accession-num><urls><related-urls><url> The transforaminal route was shown to be better than the caudal route, which in turn was better than the interlaminar route. Therefore the transforaminal route is preferred. The limited clinical effect justifies downgrading the recommendation.RecommendationsDescriptionStrength of recommendationLevel of evidenceEpidural corticosteroid administration could be used for the treatment of sub-acute lumbosacral radicular pain.Weak moderateTransforaminal epidural tumor necrosis factor alpha (TNF- α) inhibitors administrationLiterature overview: The epidural administration of tumour necrosis factor alpha (TNF-α) inhibitors was not discussed in the previous guideline.A systematic review PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XYW5nPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XYW5nPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 30 including randomised and cross-over controlled trials, non-randomised concurrent trials, before-after controlled trials, and case-control studies was found.In total 11 studies were assessed in this review.TNF-α inhibitors did not relieve lower back and leg pain significantly, at short term, medium-term and long-term follow-up (p > 0.05), in comparison to the control condition (placebo or steroid).TNF-α inhibitors did not increase the proportion of patients who felt overall satisfaction (global perceived effect) or were able to return to work at short term, medium-term and long-term follow-up (p > 0.05).TNF- α inhibitors were found to reduce the risk of discectomy or radicular block (combined endpoint; Risk Ratio (RR) = 0.51, 95% CI 0.26 to 1.00, 3 studies) at medium-term follow-up, but no effect was seen at short-term (RR = 0.64, 95% CI 0.17 to 2.40, 4 studies) and long-term follow-ups (RR = 0.64, 95% CI 0.40 to 1.03,4 studies).The review has several weaknesses and a high risk of bias. Conclusions are based on small numbers of patients and diverse studies and should therefore be treated with some caution.ConclusionsQuality of the evidence DescriptionLow There is evidence of low quality that epidural injection of Tumor Necrosis Factor alpha (TNF- α) inhibitors does not reduce low back pain better than placebo/corticosteroids in patients with lumbosacral radicular painWang YF et al. 2014Quality of the evidence DescriptionLow There is evidence of low quality that epidural injection of Tumor Necrosis Factor alpha (TNF- α) inhibitors does not reduce leg pain better than placebo/corticosteroids in patients with lumbosacral radicular pain at the short, medium, and long-term follow-up. Wang YF et al. 2014Quality of the evidence DescriptionLow There is evidence of low quality that epidural injection of Tumor Necrosis Factor alpha (TNF- α) inhibitors does not improve disability better than placebo/corticosteroids in patients with lumbosacral radicular pain. at the short, medium, and long-term follow-up. Wang YF et al. 2014Considerations:There seems to be limited clinical relevant effect in the short term for epidural administration of TNF- α inhibitors in patients with lumbosacral radicular pain.Given the limited clinical value, this should be balanced against possible side effects. Serious adverse events have been reported. In a cohort study of 71 patients who were followed over a period of 7 years, 13 serious side effects were reported (respiratory complications and malignancy)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZWxkbWFubjwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+
PFJlY051bT4xMjA4NDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3Jp
cHQiPjMxPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTIwODQ8L3Jl
Yy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ2ZXIycHdlZXlmMGRm
MmVydnhodjB4czF2Mno5eDJ6eDUyc3IiIHRpbWVzdGFtcD0iMTQ3NDA0NTQwMCI+MTIwODQ8L2tl
eT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVm
LXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhlbGRtYW5uLCBGLjwvYXV0aG9y
PjxhdXRob3I+QmFyYWxpYWtvcywgWC48L2F1dGhvcj48YXV0aG9yPktpbHR6LCBVLjwvYXV0aG9y
PjxhdXRob3I+QnJhbmR0LCBKLjwvYXV0aG9yPjxhdXRob3I+dmFuIGRlciBIb3JzdC1CcnVpbnNt
YSwgSS4gRS48L2F1dGhvcj48YXV0aG9yPkxhbmRld2UsIFIuPC9hdXRob3I+PGF1dGhvcj5TaWVw
ZXIsIEouPC9hdXRob3I+PGF1dGhvcj5CdXJtZXN0ZXIsIEcuIFIuPC9hdXRob3I+PGF1dGhvcj52
YW4gZGVuIEJvc2NoLCBGLjwvYXV0aG9yPjxhdXRob3I+ZGUgVmxhbSwgSy48L2F1dGhvcj48YXV0
aG9yPkdhc3RvbiwgSC48L2F1dGhvcj48YXV0aG9yPkdydWVua2UsIE0uPC9hdXRob3I+PGF1dGhv
cj5XaXR0LCBNLjwvYXV0aG9yPjxhdXRob3I+QXBwZWxib29tLCBULjwvYXV0aG9yPjxhdXRob3I+
RW1lcnksIFAuPC9hdXRob3I+PGF1dGhvcj5Eb3VnYWRvcywgTS48L2F1dGhvcj48YXV0aG9yPkxl
aXJpc2Fsby1SZXBvLCBNLjwvYXV0aG9yPjxhdXRob3I+QnJlYmFuLCBNLjwvYXV0aG9yPjxhdXRo
b3I+QnJhdW4sIEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl
c3M+UmhldW1hemVudHJ1bSBSdWhyZ2ViaWV0LCBIZXJuZSwgR2VybWFueS4gZnJhbmsuaGVsZG1h
bm5AZWRpYWNvbi5kZS4mI3hEO1JoZXVtYXplbnRydW0gUnVocmdlYmlldCwgSGVybmUsIEdlcm1h
bnkuJiN4RDtSaGV1bWFwcmF4aXMtU3RlZ2xpdHovQ2hhcml0ZSwgQmVybGluLCBHZXJtYW55LiYj
eEQ7VlUgTWVkaWNhbCBDZW50ZXIsIEFtc3RlcmRhbSwgdGhlIE5ldGhlcmxhbmRzLiYjeEQ7RGVw
YXJ0bWVudCBvZiBDbGluaWNhbCBJbW11bm9sb2d5IGFuZCBSaGV1bWF0b2xvZ3ksIEFjYWRlbWlj
IE1lZGljYWwgQ2VudGVyL1VuaXZlcnNpdHkgb2YgQW1zdGVyZGFtLCB0aGUgTmV0aGVybGFuZHMu
JiN4RDtDaGFyaXRlIENhbXB1cyBCZW5qYW1pbiBGcmFua2xpbiwgQmVybGluLCBHZXJtYW55LiYj
eEQ7Q2hhcml0ZSBVbml2ZXJzaXR5IE1lZGljaW5lIEJlcmxpbiwgR2VybWFueS4mI3hEO1VuaXZl
cnNpdGFpciBaaWVrZW5odWlzIEdoZW50LCBCZWxnaXVtLiYjeEQ7VW5pdmVyc2l0eSBIb3NwaXRh
bCBMZXV2ZW4sIEJlbGdpdW0uJiN4RDtMZWVkcyBJbnN0aXR1dGUgb2YgUmhldW1hdGljIGFuZCBN
dXNjdWxvc2tlbGV0YWwgTWVkaWNpbmUsIFVuaXZlcnNpdHkgb2YgTGVlZHMsIENoYXBlbCBBbGxl
cnRvbiBIb3NwaXRhbCwgTGVlZHMsIE5JSFIgTGVlZHMgTXVzY3Vsb3NrZWxldGFsIEJpb21lZGlj
YWwgUmVzZWFyY2ggVW5pdCwgTGVlZHMgVGVhY2hpbmcgSG9zcGl0YWxzIE5IUyBUcnVzdCwgTGVl
ZHMsIFVLLiYjeEQ7S2xpbmlrdW0gZGVyIFVuaXZlcnNpdGF0IE11bmNoZW4sIEdlcm1hbnkuJiN4
RDtIb3BpdGFsIEVyYXNtZSBCcnVzc2VscywgQmVsZ2l1bS4mI3hEO1VuaXZlcnNpdHkgb2YgTGVl
ZHMsIFVLLiYjeEQ7SG9waXRhbCBDb2NoaW4gUGFyaXMsIEZyYW5jZS4mI3hEO0hlbHNpbmtpIFVu
aXZlcnNpdHkgQ2VudHJhbCBIb3NwaXRhbCwgSGVsc2lua2ksIEZpbmxhbmQuJiN4RDtIb3BpdGFs
IEFtYnJvaXNlIFBhcmUsIEJvdWxvZ25lLCBGcmFuY2UuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48
dGl0bGU+Q2xpbmljYWwgZXhwZXJpZW5jZSB3aXRoIHRoZSBFdXJvcGVhbiBBbmt5bG9zaW5nIFNw
b25keWxpdGlzIEluZmxpeGltYWIgQ29ob3J0IChFQVNJQyk6IGxvbmctdGVybSBleHRlbnNpb24g
b3ZlciA3IHllYXJzIHdpdGggZm9jdXMgb24gY2xpbmljYWwgZWZmaWNhY3kgYW5kIHNhZmV0eTwv
dGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIEV4cCBSaGV1bWF0b2w8L3NlY29uZGFyeS10aXRs
ZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DbGluIEV4cCBSaGV1bWF0b2w8L2Z1
bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xODQtOTA8L3BhZ2VzPjx2b2x1bWU+MzQ8L3Zv
bHVtZT48bnVtYmVyPjI8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+
PGtleXdvcmQ+QW50aXJoZXVtYXRpYyBBZ2VudHMvYWR2ZXJzZSBlZmZlY3RzLyp0aGVyYXBldXRp
YyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+Qy1SZWFjdGl2ZSBQcm90ZWluL2FuYWx5c2lzPC9rZXl3
b3JkPjxrZXl3b3JkPkNvaG9ydCBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5
d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5mbGl4aW1hYi9hZHZlcnNl
IGVmZmVjdHMvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3Jk
PjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlNwb25keWxpdGlzLCBBbmt5
bG9zaW5nL2Jsb29kLypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+VHVtb3IgTmVjcm9z
aXMgRmFjdG9yLWFscGhhLyphbnRhZ29uaXN0cyAmYW1wOyBpbmhpYml0b3JzPC9rZXl3b3JkPjwv
a2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXItQXBy
PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MDM5Mi04NTZYIChQcmludCkmI3hEOzAz
OTItODU2WCAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjcwNDk3MzM8L2FjY2Vzc2lv
bi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5n
b3YvcHVibWVkLzI3MDQ5NzMzPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjwvcmVjb3JkPjwv
Q2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZWxkbWFubjwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+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ADDIN EN.CITE.DATA 31. Neurological complications at the central and peripheral nervous system have been reported. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5ab2lzPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5ab2lzPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 32 Recommendations:DescriptionStrength of recommendationLevel of evidenceEpidural Tumor Necrosis Factor alpha (TNF – α) inhibitors administration could not be used for the management of lumbosacral radicular painWeak againstLowRadiofrequency treatment adjacent to the lumbar ganglion spinale (DRG) Literature overview:The negative recommendation formulated in the previous guideline ADDIN EN.CITE <EndNote><Cite><Author>Van Boxem</Author><Year>2010</Year><RecNum>5517</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>5517</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5517</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Van Boxem, K.</author><author>Cheng, J.</author><author>Patijn, J.</author><author>van Kleef, M.</author><author>Lataster, A.</author><author>Mekhail, N.</author><author>Van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.</auth-address><titles><title>11. Lumbosacral radicular pain</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>339-58</pages><volume>10</volume><number>4</number><edition>2010/05/25</edition><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1533-2500 (Electronic)
1530-7085 (Linking)</isbn><accession-num>20492580</accession-num><urls><related-urls><url> [pii]
10.1111/j.1533-2500.2010.00370.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 was based on the RCT on 83 patients comparing RF treatment with a sham intervention. At 3 months follow-up no differences were seen between the two groups. ADDIN EN.CITE <EndNote><Cite><Author>Geurts</Author><Year>2003</Year><RecNum>1661</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><rec-number>1661</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1661</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Geurts, J. W.</author><author>van Wijk, R. M.</author><author>Wynne, H. J.</author><author>Hammink, E.</author><author>Buskens, E.</author><author>Lousberg, R.</author><author>Knape, J. T.</author><author>Groen, G. J.</author></authors></contributors><auth-address>Division of Perioperative Medicine, Anaesthesiology, and Pain Management, University Medical Centre Utrecht, Utrecht, Netherlands. anesthesiologen.arnhem@planet.nl</auth-address><titles><title>Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-blind, controlled trial</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>21-6</pages><volume>361</volume><number>9351</number><keywords><keyword>*Catheter Ablation</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Ganglia, Spinal/*surgery</keyword><keyword>Humans</keyword><keyword>Lumbosacral Region</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Netherlands</keyword><keyword>Pain/*etiology/therapy</keyword><keyword>Pain Measurement</keyword><keyword>Radiculopathy/*surgery</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2003</year><pub-dates><date>Jan 4</date></pub-dates></dates><accession-num>12517462</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>33Evidence on the effectiveness of conventional radiofrequency was taken from a systematic review, that did not identify additional studies beyond those in the previous guidance. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Qb3BlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Qb3BlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 34 Our search for randomized trials postdating the review did not identify any further trials. We consider that the evidence has not changed since the publication of the previous guideline. ADDIN EN.CITE <EndNote><Cite><Author>van Zundert</Author><Year>2012</Year><RecNum>24</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="w09dw9et8sfxe4ev094vsttywzet9p5aaxv2" timestamp="1400231138">24</key></foreign-keys><ref-type name="Edited Book">28</ref-type><contributors><authors><author>van Zundert, J.</author><author>Patijn, J.</author><author>Hartrick, C.T.</author><author>Lataster, A.</author><author>Huygen, F.J.P.M.</author><author>Mekhail, N.</author><author>van Kleef, M.</author></authors></contributors><titles><title>Evidence-based interventional pain medicine: according to clinical diagnoses </title></titles><dates><year>2012</year></dates><pub-location>Chichester</pub-location><publisher>Wiley-Blackwell</publisher><urls></urls><custom2>DAF</custom2><custom4>SBD. Added 16.5.14</custom4><custom6> </custom6></record></Cite></EndNote>35 ConclusionQuality of the evidence DescriptionModerateThere is evidence of moderate quality that radiofrequency treatment adjacent to the lumbar ganglion spinale (dorsal root ganglion (DRG)) is not better than sham intervention. RecommendationDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment adjacent to the lumbar ganglion spinale (dorsal root ganglion (DRG)) should not be used for the management of lumbosacral radicular pain.moderate againstmoderatePulsed radiofrequency treatment adjacent to the lumbar ganglion spinale (DRG)Literature overviewThe recommendations that PRF treatment adjacent to the lumbar ganglion spinale (DRG) can be considered, preferable study related, in the previous guideline were based on two retrospective studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UZWl4ZWlyYTwvQXV0aG9yPjxZZWFyPjIwMDU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UZWl4ZWlyYTwvQXV0aG9yPjxZZWFyPjIwMDU8L1llYXI+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ADDIN EN.CITE.DATA 36, 37. One additional RCT aimed at assessing if RF immediate after the PRF treatment improves the outcome, was found to have methodological weaknesses and was therefore not included. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaW1vcG91bG9zPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaW1vcG91bG9zPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE.DATA 38 A systematic review ADDIN EN.CITE <EndNote><Cite><Author>Pope</Author><Year>2013</Year><RecNum>10748</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>10748</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1393592108">10748</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pope, J. E.</author><author>Deer, T. R.</author><author>Kramer, J.</author></authors></contributors><auth-address>The Center for Pain Relief, Charleston, West Virginia.</auth-address><titles><title>A Systematic Review: Current and Future Directions of Dorsal Root Ganglion Therapeutics to Treat Chronic Pain</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>Pain Med</full-title></periodical><dates><year>2013</year><pub-dates><date>Jun 26</date></pub-dates></dates><accession-num>23802747</accession-num><urls><related-urls><url> confirmed that up to December 2012 only observational studies were available to assess the efficacy of pulsed radiofrequency of the dorsal root ganglion for the treatment of lumbosacral radicular pain. It identified two additional retrospective studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW4gQm94ZW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFy
PjxSZWNOdW0+MTAwNzI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2Ny
aXB0Ij40MCwgNDE8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4xMDA3
MjwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InZlcjJwd2Vl
eWYwZGYyZXJ2eGh2MHhzMXYyejl4Mnp4NTJzciIgdGltZXN0YW1wPSIwIj4xMDA3Mjwva2V5Pjwv
Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw
ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+VmFuIEJveGVtLCBLLjwvYXV0aG9yPjxh
dXRob3I+dmFuIEJpbHNlbiwgSi48L2F1dGhvcj48YXV0aG9yPmRlIE1laWosIE4uPC9hdXRob3I+
PGF1dGhvcj5IZXJybGVyLCBBLjwvYXV0aG9yPjxhdXRob3I+S2Vzc2VscywgRi48L2F1dGhvcj48
YXV0aG9yPlZhbiBadW5kZXJ0LCBKLjwvYXV0aG9yPjxhdXRob3I+dmFuIEtsZWVmLCBNLjwvYXV0
aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2Yg
QW5lc3RoZXNpb2xvZ3kgYW5kIFBhaW4gTWFuYWdlbWVudCwgTWFhc3RyaWNodCBVbml2ZXJzaXR5
IE1lZGljYWwgQ2VudHJlLCBNYWFzdHJpY2h0LCBUaGUgTmV0aGVybGFuZHMuIGtvZW4udmJAdGVs
ZW5ldC5iZTwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlB1bHNlZCByYWRpb2ZyZXF1ZW5j
eSB0cmVhdG1lbnQgYWRqYWNlbnQgdG8gdGhlIGx1bWJhciBkb3JzYWwgcm9vdCBnYW5nbGlvbiBm
b3IgdGhlIG1hbmFnZW1lbnQgb2YgbHVtYm9zYWNyYWwgcmFkaWN1bGFyIHN5bmRyb21lOiBhIGNs
aW5pY2FsIGF1ZGl0PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPlBhaW4gTWVkPC9zZWNvbmRhcnkt
dGl0bGU+PHNob3J0LXRpdGxlPmx1bWJvc2FjcmFsIHJhZGljdWxhciBwYWluIDwvc2hvcnQtdGl0
bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+UGFpbiBNZWQ8L2Z1bGwtdGl0bGU+
PC9wZXJpb2RpY2FsPjxwYWdlcz4xMzIyLTMwPC9wYWdlcz48dm9sdW1lPjEyPC92b2x1bWU+PG51
bWJlcj45PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+
RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhbmdsaWEsIFNwaW5hbC9waHlzaW9wYXRob2xvZ3kv
KnN1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkx1bWJh
ciBWZXJ0ZWJyYWUvcGh5c2lvcGF0aG9sb2d5LypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPk1h
bGU8L2tleXdvcmQ+PGtleXdvcmQ+TWVkaWNhbCBBdWRpdC8qbWV0aG9kczwva2V5d29yZD48a2V5
d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5QdWxzZWQgUmFkaW9mcmVxdWVuY3kg
VHJlYXRtZW50LyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPlJhZGljdWxvcGF0aHkvKmV0aW9s
b2d5L3BoeXNpb3BhdGhvbG9neS8qdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5TcGluYWwgTmVy
dmUgUm9vdHMvcGh5c2lvcGF0aG9sb2d5L3N1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+U3BvbmR5
bG9zaXMvY29tcGxpY2F0aW9ucy9waHlzaW9wYXRob2xvZ3kvKnN1cmdlcnk8L2tleXdvcmQ+PGtl
eXdvcmQ+U3luZHJvbWU8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdv
cmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHViLWRhdGVzPjxkYXRlPlNl
cDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxvcmlnLXB1Yj5jbGluaWNhbCBhdWRpdDwvb3Jp
Zy1wdWI+PGFjY2Vzc2lvbi1udW0+MjE4MTI5MDc8L2FjY2Vzc2lvbi1udW0+PHdvcmstdHlwZT5Q
UkY8L3dvcmstdHlwZT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5s
bS5uaWguZ292L3B1Ym1lZC8yMTgxMjkwNzwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48L3Jl
Y29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5OYWdkYTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
PFJlY051bT4xMDA0NDwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MTAwNDQ8L3JlYy1udW1i
ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ2ZXIycHdlZXlmMGRmMmVydnho
djB4czF2Mno5eDJ6eDUyc3IiIHRpbWVzdGFtcD0iMCI+MTAwNDQ8L2tleT48L2ZvcmVpZ24ta2V5
cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1
dG9ycz48YXV0aG9ycz48YXV0aG9yPk5hZ2RhLCBKLiBWLjwvYXV0aG9yPjxhdXRob3I+RGF2aXMs
IEMuIFcuPC9hdXRob3I+PGF1dGhvcj5CYWp3YSwgWi4gSC48L2F1dGhvcj48YXV0aG9yPlNpbW9w
b3Vsb3MsIFQuIFQuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl
c3M+RGVwYXJ0bWVudCBvZiBBbmVzdGhlc2lhLCBDcml0aWNhbCBDYXJlLCBhbmQgUGFpbiBNZWRp
Y2luZSwgQmV0aCBJc3JhZWwgRGVhY29uZXNzIE1lZGljYWwgQ2VudGVyLCBIYXJ2YXJkIE1lZGlj
YWwgU2Nob29sLCBCb3N0b24sIE1BIDAyMjE1LCBVU0EuIGpuYWdkYUBiaWRtYy5oYXJ2YXJkLmVk
dTwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlJldHJvc3BlY3RpdmUgcmV2aWV3IG9mIHRo
ZSBlZmZpY2FjeSBhbmQgc2FmZXR5IG9mIHJlcGVhdGVkIHB1bHNlZCBhbmQgY29udGludW91cyBy
YWRpb2ZyZXF1ZW5jeSBsZXNpb25pbmcgb2YgdGhlIGRvcnNhbCByb290IGdhbmdsaW9uL3NlZ21l
bnRhbCBuZXJ2ZSBmb3IgbHVtYmFyIHJhZGljdWxhciBwYWluPC90aXRsZT48c2Vjb25kYXJ5LXRp
dGxlPlBhaW4gUGh5c2ljaWFuPC9zZWNvbmRhcnktdGl0bGU+PHNob3J0LXRpdGxlPnJhZGljdWxh
ciBwYWluIDwvc2hvcnQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+UGFp
biBQaHlzaWNpYW48L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4zNzEtNjwvcGFnZXM+
PHZvbHVtZT4xNDwvdm9sdW1lPjxudW1iZXI+NDwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5B
ZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQsIDgwIGFu
ZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkNhdGhldGVyIEFibGF0aW9uL2FkdmVyc2UgZWZmZWN0
cy8qbWV0aG9kczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2Fu
Z2xpYSwgU3BpbmFsLypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48
a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3
b3JkPk5ldXJhbGdpYS9ldGlvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5SYWRpY3Vs
b3BhdGh5L2NvbXBsaWNhdGlvbnMvKnN1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+UmFkaW8gV2F2
ZXMvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5SZXRyb3NwZWN0aXZlIFN0dWRp
ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHViLWRhdGVz
PjxkYXRlPkp1bC1BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48b3JpZy1wdWI+cmV0cm9z
cGVjdGl2ZTwvb3JpZy1wdWI+PGFjY2Vzc2lvbi1udW0+MjE3ODU0ODA8L2FjY2Vzc2lvbi1udW0+
PGxhYmVsPlJGIDIwMTQmI3hEOzwvbGFiZWw+PHdvcmstdHlwZT5QUkY8L3dvcmstdHlwZT48dXJs
cz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC8y
MTc4NTQ4MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48L3JlY29yZD48L0NpdGU+PC9FbmRO
b3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW4gQm94ZW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFy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ADDIN EN.CITE.DATA 40, 41 to supplement the previous guideline. ADDIN EN.CITE <EndNote><Cite><Author>Van Boxem</Author><Year>2010</Year><RecNum>5517</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>5517</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5517</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Van Boxem, K.</author><author>Cheng, J.</author><author>Patijn, J.</author><author>van Kleef, M.</author><author>Lataster, A.</author><author>Mekhail, N.</author><author>Van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.</auth-address><titles><title>11. Lumbosacral radicular pain</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>339-58</pages><volume>10</volume><number>4</number><edition>2010/05/25</edition><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1533-2500 (Electronic)
1530-7085 (Linking)</isbn><accession-num>20492580</accession-num><urls><related-urls><url> [pii]
10.1111/j.1533-2500.2010.00370.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 An additional search for randomized controlled trials published subsequently revealed two RCTs, one of which was published in Japanese and not available as a full text paper thus preventing to draw conclusions on the effectiveness of PRF from this paper. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GdWppaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GdWppaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA 42 The other was a pilot study which main aim was to consider the feasibility of assessing the efficacy of PRF-DRG when compared to placebo. ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 This was a well-conducted pilot RCT. However the focus of the trial was on recruitment rate and completeness of follow-up. ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 The trial was not powered to detect differences in clinical effectiveness as calculation of power needed for a larger efficacy trial was part of the aim of this pilot trial. ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 Neither was the trial designed to assess long-term effectiveness of treatment (participants were followed up to 3 months). ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 The conclusions of this pilot trial were that the relative benefit of PRF was small which might create difficulties for the recruitment of a sufficient number of patients for a larger trial. ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 The authors of the review advised that, until clear parameters for the application of PRF are established, clinicians may have to rely on individual judgement. ADDIN EN.CITE <EndNote><Cite><Author>Shanthanna</Author><Year>2014</Year><RecNum>10424</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>10424</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390302591">10424</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shanthanna, H</author><author>Chan, P</author><author>McChesney, J</author><author>Thabane, L</author><author>Paul, J</author></authors></contributors><titles><title>Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study</title><secondary-title>Journal of Pain Research</secondary-title><short-title>lumbar radicular</short-title></titles><periodical><full-title>Journal of Pain Research</full-title></periodical><pages>47-55</pages><volume>7</volume><number>1</number><dates><year>2014</year></dates><orig-pub>RCT</orig-pub><label>RF 2014</label><work-type>PRF</work-type><urls></urls></record></Cite></EndNote>43 We agree with this conclusion and would not consider the evidence to have advanced beyond the rating of the previous guideline. ADDIN EN.CITE <EndNote><Cite><Author>Van Boxem</Author><Year>2010</Year><RecNum>5517</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>5517</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">5517</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Van Boxem, K.</author><author>Cheng, J.</author><author>Patijn, J.</author><author>van Kleef, M.</author><author>Lataster, A.</author><author>Mekhail, N.</author><author>Van Zundert, J.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.</auth-address><titles><title>11. Lumbosacral radicular pain</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>339-58</pages><volume>10</volume><number>4</number><edition>2010/05/25</edition><dates><year>2010</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1533-2500 (Electronic)
1530-7085 (Linking)</isbn><accession-num>20492580</accession-num><urls><related-urls><url> [pii]
10.1111/j.1533-2500.2010.00370.x</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 The review of Pope ADDIN EN.CITE <EndNote><Cite><Author>Pope</Author><Year>2013</Year><RecNum>10748</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>10748</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1393592108">10748</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pope, J. E.</author><author>Deer, T. R.</author><author>Kramer, J.</author></authors></contributors><auth-address>The Center for Pain Relief, Charleston, West Virginia.</auth-address><titles><title>A Systematic Review: Current and Future Directions of Dorsal Root Ganglion Therapeutics to Treat Chronic Pain</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>Pain Med</full-title></periodical><dates><year>2013</year><pub-dates><date>Jun 26</date></pub-dates></dates><accession-num>23802747</accession-num><urls><related-urls><url> has several methodological weaknesses and a high risk of bias.Conclusion:Quality of the evidence DescriptionModerate There is evidence of moderate quality that pulsed radiofrequency treatment adjacent to the lumbar ganglion spinale (dorsal root ganglion (DRG)) reduces pain in patients with lumbosacral radicular pain for up to 6 months. Van Boxem K et al. 2010; Pope et al. 2013; Van Boxem K et al. 2011; Nagda et al. 2011; Fuji H et al. 2012; Shanthanna H et al. 2014ConsiderationsPRF adjacent to the lumbar DRG may have a clinical relevant effect on lumbosacral radicular painNo complications have been reportedA prospective cohort study to evaluate the effect of PRF adjacent to the lumbar DRG on pain and quality of life included 65 patients with unilateral and monosegmental radiating pain At 6 months follow-up the intention-to-treat analysis showed clinical success in 55.4% of the patients. The reduction in NRS and ODI was statistical significant compared to baseline. Also the DN4 showed a significant improvement, indicating that the neuropathic component of the radicular pain is reduced after PRF treatment . The RAND-36 showed significant improvement in the physical component scale at 3 and 6 months. The information of this study was used to assess the non-psychological parameters that may be predictive for the treatment outcome. A positive diagnostic block of the corresponding nerve root was predictive for treatment success. Clinical success at 6 months is better in patients older than 55 years. High disability is a negative predictor for successful outcome of PRF adjacent to the DRG. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW4gQm94ZW08L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW4gQm94ZW08L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFy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ADDIN EN.CITE.DATA 44A randomized double-blind controlled trial (62 particpants) compared the effect of 3 cycles of PRF treatment adjacent to the lumbar DRG (during the same session) with sham intervention in patients with MRI proven spinal canal stenosis. All participants also received a transforaminal epidural steroid injection after the PRF or sham procedure. Participants had ≥ 2point pain reduction after a transforaminal epidural injection of local anesthetic and corticosteroid for a short duration (≤ 6 weeks). Patients in the PRF group showed a significant greater improvement on a composite score for successful treatment during the 3 months follow-up than patients in the control group, but not on individual outcomes (mean difference pain reduction (0.331 (?0.252 to 0.914)), functional status, global perceived effect and oral analgesic use). PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb2g8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb2g8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA 45In another RCT (20 participants with lumbar radiculopathy) comparing PRF adjacent to the lumbar ganglion spinale (DRG) with transforaminal corticosteroid injections for patients with radicular pain, there were no differences in pain and functioning at 2, 4, 8 and 12 weeks. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNO
dW0+MTIzOTc8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij40
Njwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEyMzk3PC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idmVyMnB3ZWV5ZjBkZjJlcnZ4
aHYweHMxdjJ6OXgyeng1MnNyIiB0aW1lc3RhbXA9IjE0OTM4NzkxNjQiPjEyMzk3PC9rZXk+PC9m
b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl
Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5MZWUsIEQuIEcuPC9hdXRob3I+PGF1dGhv
cj5BaG4sIFMuIEguPC9hdXRob3I+PGF1dGhvcj5MZWUsIEouPC9hdXRob3I+PC9hdXRob3JzPjwv
Y29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBQaHlzaWNhbCBNZWRpY2lu
ZSAmYW1wOyBSZWhhYmlsaXRhdGlvbiwgRG9uZ3NhbiBNZWRpY2FsIENlbnRlciwgS2VpbXl1bmcg
VW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUsIERhZWd1LCBLb3JlYSAuJiN4RDtEZXBhcnRt
ZW50IG9mIFBoeXNpY2FsIE1lZGljaW5lICZhbXA7IFJlaGFiaWxpdGF0aW9uLCBZZXVuZ25hbSBV
bml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgRGFlZ3UsIEtvcmVhIC48L2F1dGgtYWRkcmVz
cz48dGl0bGVzPjx0aXRsZT5Db21wYXJhdGl2ZSBFZmZlY3RpdmVuZXNzZXMgb2YgUHVsc2VkIFJh
ZGlvZnJlcXVlbmN5IGFuZCBUcmFuc2ZvcmFtaW5hbCBTdGVyb2lkIEluamVjdGlvbiBmb3IgUmFk
aWN1bGFyIFBhaW4gZHVlIHRvIERpc2MgSGVybmlhdGlvbjogYSBQcm9zcGVjdGl2ZSBSYW5kb21p
emVkIFRyaWFsPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkogS29yZWFuIE1lZCBTY2k8L3NlY29u
ZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KIEtvcmVhbiBNZWQg
U2NpPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MTMyNC0zMDwvcGFnZXM+PHZvbHVt
ZT4zMTwvdm9sdW1lPjxudW1iZXI+ODwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwv
a2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48
a2V5d29yZD5HYW5nbGlhLCBTcGluYWwvcmFkaWF0aW9uIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdv
cmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkluamVjdGlvbnMsIEVwaWR1cmFsPC9rZXl3b3Jk
PjxrZXl3b3JkPkludGVydmVydGVicmFsIERpc2MgRGlzcGxhY2VtZW50LypkaWFnbm9zaXM8L2tl
eXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29y
ZD48a2V5d29yZD5QYWluLypkcnVnIHRoZXJhcHkvKnJhZGlvdGhlcmFweTwva2V5d29yZD48a2V5
d29yZD5QYWluIE1lYXN1cmVtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRp
ZXM8L2tleXdvcmQ+PGtleXdvcmQ+KlB1bHNlZCBSYWRpb2ZyZXF1ZW5jeSBUcmVhdG1lbnQ8L2tl
eXdvcmQ+PGtleXdvcmQ+U3Rlcm9pZHMvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29y
ZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48a2V5d29yZD5QdWxzZWQgUmFkaW9mcmVxdWVu
Y3kgVHJlYXRtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlJhZGljdWxhciBQYWluPC9rZXl3b3JkPjxr
ZXl3b3JkPlRyYW5zZm9yYW1pbmFsIEVwaWR1cmFsIFN0ZXJvaWQgSW5qZWN0aW9uPC9rZXl3b3Jk
Pjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BdWc8
L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTk4LTYzNTcgKEVsZWN0cm9uaWMpJiN4
RDsxMDExLTg5MzQgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI3NDc4MzQ2PC9hY2Nl
c3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5u
aWguZ292L3B1Ym1lZC8yNzQ3ODM0NjwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48Y3VzdG9t
Mj5QTUM0OTUxNTY1PC9jdXN0b20yPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4zMzQ2L2pr
bXMuMjAxNi4zMS44LjEzMjQ8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0
ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA 46 In another prospective RCT 50 patients with lumbosacral radicular pain refractory to transforaminal epidural steroids received conventional monopolar or bipolar (2 cannulae tips) PRF adjacent to the lumbar ganglion spinale (DRG). In the bipolar group the pretreatment pain intensity (NRS 0-10) was 5.1±0.8. At 1 month, the mean NRS was 2.5±1.5, at 2 months, 2.6±1.6, and at 3 months, 2.6±1.7. In the monopolar PRF group, the mean NRS decreased from 4.6±0.8 pretreatment to 3.0±1.5 at 1 month, 3.0±1.5 at 2 months, and 3.0±1.5 at 3 months. Three months after treatment, 76% in the bipolar versus 48% in the monopolar PRF group reported successful pain relief (≥ 50% pain reduction). ADDIN EN.CITE <EndNote><Cite><Author>Chang</Author><Year>2017</Year><RecNum>12396</RecNum><DisplayText><style face="superscript">47</style></DisplayText><record><rec-number>12396</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1493878946">12396</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chang, M. C.</author><author>Cho, Y. W.</author><author>Ahn, S. H.</author></authors></contributors><auth-address>aDepartment of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University bDr Ahn's Spine & Pain Clinic, and Dr Ahn's Spine and Pain Institute, Taegu, Republic of Korea.</auth-address><titles><title>Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain: A randomized controlled trial</title><secondary-title>Medicine (Baltimore)</secondary-title><short-title>Lumbosacral radicular pain</short-title></titles><periodical><full-title>Medicine (Baltimore)</full-title></periodical><pages>e6236</pages><volume>96</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Chronic Pain/*therapy</keyword><keyword>Female</keyword><keyword>Ganglia, Spinal</keyword><keyword>Humans</keyword><keyword>Low Back Pain/*therapy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>*Pulsed Radiofrequency Treatment</keyword></keywords><dates><year>2017</year><pub-dates><date>Mar</date></pub-dates></dates><orig-pub>RCT</orig-pub><isbn>1536-5964 (Electronic)
0025-7974 (Linking)</isbn><accession-num>28248888</accession-num><work-type>PRF</work-type><urls><related-urls><url>. Recommendations:DescriptionStrength of recommendationLevel of evidencePulsed radiofrequency could be considered in patients with chronic lumbosacral radicular pain. ModerateModerateReferences ADDIN EN.REFLIST 1Van Boxem K, Cheng J, Patijn J, van Kleef M, Lataster A, Mekhail N, Van Zundert J. 11. Lumbosacral radicular pain. Pain Pract. 2010;10:339-358.2Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S, Fitzsimmons D, Rickard I, Wilkinson C. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015;15:1461-1477.3Bicket MC, Chakravarthy K, Chang D, Cohen SP. Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag. 2015;5:129-146.4Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157:865-877.5Quraishi NA. Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis. Eur Spine J. 2012;21:214-219.6Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011;20:513-522.7Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J. 2012;21:204-213.8Benyamin RM, Manchikanti L, Parr AT, Diwan S, Singh V, Falco FJ, Datta S, Abdi S, Hirsch JA. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician. 2012;15:E363-404.9Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15:E199-245.10Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review. Clin Orthop Relat Res. 2015;473:1940-1956.11MacVicar J, King W, Landers MH, Bogduk N. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med. 2013;14:14-28.12Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12:233-251.13Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009;34:1078-1093.14Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician. 2009;12:163-188.15Benny B, Azari P. The efficacy of lumbosacral transforaminal epidural steroid injections: a comprehensive literature review. Journal of back and musculoskeletal rehabilitation. 2011;24:67-76.16Chang-Chien GC, Knezevic NN, McCormick Z, Chu SK, Trescot AM, Candido KD. Transforaminal versus interlaminar approaches to epidural steroid injections: a systematic review of comparative studies for lumbosacral radicular pain. Pain Physician. 2014;17:E509-524.17Bui J, Bogduk N. A systematic review of the effectiveness of CT-guided, lumbar transforaminal injection of steroids. Pain Med. 2013;14:1860-1865.18Shamliyan TA, Staal JB, Goldmann D, Sands-Lincoln M. Epidural steroid injections for radicular lumbosacral pain: a systematic review. Phys Med Rehabil Clin N Am. 2014;25:471-489 e471-450.19Peul WC, Brand R, Thomeer RT, Koes BW. Influence of gender and other prognostic factors on outcome of sciatica. Pain. 2008;138:180-191.20Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L, Smith W, Carver R, Maratukulam A, Won LA, Carragee E, Avins AL. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015;313:1915-1923.21Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010:CD007612.22Deyo RA, Mirza SK. CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016;374:1763-1772.23Spijker-Huiges A, Vermeulen K, Winters JC, van Wijhe M, van der Meer K. Costs and cost-effectiveness of epidural steroids for acute lumbosacral radicular syndrome in general practice: an economic evaluation alongside a pragmatic randomized control trial. Spine (Phila Pa 1976). 2014;39:2007-2012.24Fitzsimmons D, Phillips CJ, Bennett H, Jones M, Williams N, Lewis R, Sutton A, Matar HE, Din N, Burton K, Nafees S, Hendry M, Rickard I, Wilkinson C. Cost-effectiveness of different strategies to manage patients with sciatica. Pain. 2014;155:1318-1327.25van Helvoirt H, Apeldoorn AT, Ostelo RW, Knol DL, Arts MP, Kamper SJ, van Tulder MW. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation. Pain Med. 2014;15:1100-1108.26FDA Epidural Steroid Injections (ESI) and the Risk of Serious Neurologic Adverse Reactions. In: Anesthetic and Analgesic Drug Products Advisory Committee, ed. Anesthetic and Analgesic Drug Products Advisory Committee: Briefing document2014.27Racoosin JA, Seymour SM, Cascio L, Gill R. Serious Neurologic Events after Epidural Glucocorticoid Injection--The FDA's Risk Assessment. N Engl J Med. 2015;373:2299-2301.28McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011;12:726-731.29Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med. 2013;38:175-200.30Wang YF, Chen PY, Chang W, Zhu FQ, Xu LL, Wang SL, Chang LY, Luo J, Liu GJ. Clinical significance of tumor necrosis factor-alpha inhibitors in the treatment of sciatica: a systematic review and meta-analysis. PLoS One. 2014;9:e103147.31Heldmann F, Baraliakos X, Kiltz U, Brandt J, van der Horst-Bruinsma IE, Landewe R, Sieper J, Burmester GR, van den Bosch F, de Vlam K, Gaston H, Gruenke M, Witt M, Appelboom T, Emery P, Dougados M, Leirisalo-Repo M, Breban M, Braun J. Clinical experience with the European Ankylosing Spondylitis Infliximab Cohort (EASIC): long-term extension over 7 years with focus on clinical efficacy and safety. Clin Exp Rheumatol. 2016;34:184-190.32Zois CD, Katsanos KH, Kosmidou M, Tsianos EV. Neurologic manifestations in inflammatory bowel diseases: current knowledge and novel insights. J Crohns Colitis. 2010;4:115-124.33Geurts JW, van Wijk RM, Wynne HJ, Hammink E, Buskens E, Lousberg R, Knape JT, Groen GJ. Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-blind, controlled trial. Lancet. 2003;361:21-26.34Pope JE, Deer TR, Kramer J. A systematic review: current and future directions of dorsal root ganglion therapeutics to treat chronic pain. Pain Med. 2013;14:1477-1496.35van Zundert J, Patijn J, Hartrick CT, Lataster A, Huygen FJPM, Mekhail N, van Kleef M, eds. Evidence-based interventional pain medicine: according to clinical diagnoses Chichester: Wiley-Blackwell; 2012.36Teixeira A, Grandinson M, Sluijter M. Pulsed Radiofrequency for radicular pain due to a herniated intervertebral disc - an initial report. Pain Practice. 2005;5:111-115.37Abejon D, Garcia-del-Valle S, Fuentes ML, Gomez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract. 2007;7:21-26.38Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician. 2008;11:137-144.39Pope JE, Deer TR, Kramer J. A Systematic Review: Current and Future Directions of Dorsal Root Ganglion Therapeutics to Treat Chronic Pain. Pain Med. 2013.40Van Boxem K, van Bilsen J, de Meij N, Herrler A, Kessels F, Van Zundert J, van Kleef M. Pulsed radiofrequency treatment adjacent to the lumbar dorsal root ganglion for the management of lumbosacral radicular syndrome: a clinical audit. Pain Med. 2011;12:1322-1330.41Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Pain Physician. 2011;14:371-376.42Fujii H, Kosogabe Y, Kajiki H. [Long-term effects of pulsed radiofrequency on the dorsal root ganglion and segmental nerve roots for lumbosacral radicular pain: a prospective controlled randomized trial with nerve root block]. Masui. The Japanese journal of anesthesiology. 2012;61:790-793.43Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study. Journal of Pain Research. 2014;7:47-55.44Van Boxem K, de Meij N, Patijn J, Wilmink J, van Kleef M, Van Zundert J, Kessels A. Predictive Factors for Successful Outcome of Pulsed Radiofrequency Treatment in Patients with Intractable Lumbosacral Radicular Pain. Pain Med. 2016;17:1233-1240.45Koh W, Choi SS, Karm MH, Suh JH, Leem JG, Lee JD, Kim YK, Shin J. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. Pain Med. 2015;16:432-441.46Lee DG, Ahn SH, Lee J. Comparative Effectivenesses of Pulsed Radiofrequency and Transforaminal Steroid Injection for Radicular Pain due to Disc Herniation: a Prospective Randomized Trial. J Korean Med Sci. 2016;31:1324-1330.47Chang MC, Cho YW, Ahn SH. Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain: A randomized controlled trial. Medicine (Baltimore). 2017;96:e6236. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.