Background: The efficacy of particulate and non-particulate steroids in patients receiving
epidural steroid injections remains unclear.
Objective: The purpose of this meta-analysis was to compare the efficacy of particulate
and non-particulate steroids in patients receiving epidural injections for radicular pain over 3
months.
Study Design: Systematic review and meta-analysis.
Methods: We reviewed PubMed, PubMed Central, Scopus, Central Register of Clinical
Trials of the Cochrane Collaboration, Google Scholar, and Directory of open access journals
for trials that compared efficacy of particulate steroid with non-particulate. A meta-analysis
was performed on treatment related to mean change in visual analogue score (VAS) between
the particulate and non-particulate steroids. Two authors independently reviewed the data for
inclusion.
Results: Seven studies comprising 3,542 patients in the particulate group and 856 patients in
the non-particulate group were included. Pooled mean maximum change of VAS was higher by
0.53 (95% CI: 0.14 to 0.92; P = 0.007; I2 = 50.2%) in the particulate group compared to the
non-particulate group. The non-particulate group had a larger proportion of patients with more
than 50% pain relief than the particulate group [OR 0.81 (95% CI: 0.68 to 0.97, P = 0.024).
Limitations: Limited number of trials that fit the inclusion criteria and were available for
analysis.
Conclusions: As the use of particulate steroids seems to be associated with slightly better
VAS scores only, clinicians need to weigh their clinical relevance in the light of complications
and recent FDA recommendations on the use of particulate steroids.
Key words: Meta-analysis, particulate epidural steroids, non-partiuclate epidural steroids,
efficacy, decrease in pain scores
Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review
