Tuesday, October 28, 2014 New Study: Steroid Treatments Shouldn't Be the 'First-Line Stand-Alone' Approach to Neck Pain Authors of a new study say that epidural steroid injections used as a stand-alone treatment should not be a "first line" approach to cervical radicular pain, and instead suggest that a combination of treatments including physical therapy may offer the best chances for improvement. In a multicenter, randomized study published in the November issue of Anesthesiology, researchers tracked treatment outcomes for 3 groups of patients with neck pain that radiated through the shoulders and arms. A total of 55 patients received epidural steroid injection (ESI); 59 received pain medication and physical therapy; and 55 had both treatments. The study measured pain scores at outset, and 1, 3, and 6 months after treatments began. What researchers found was that both the conservative and steroid-only treatment groups improved at the same rate, and that while patients in the combination group reported greater rates of pain reduction, "the difference reached statistical significance only at 3 months." At that measurement point, 56.9% of the combination group reported decreased arm pain, compared with 36.7% of the steroid-only group and 26.8% of the conservative treatment group. "The main finding is that although the combination group experienced superior results for some outcome measures compared with stand-alone therapies, most differences generally fell shy of statistical significance, including for the primary outcome measure," authors write. "On the basis of these findings and the risks associated with ESI, one might reasonably conclude that ESI should not be a first-line, stand-alone treatment for cervical radiculopathy." Although authors did acknowledge that the combination group seemed to fare better than the stand-alone groups, they noted that "the effect size was more modest than we anticipated." Still, they offer several explanations for the differences, including the ways the treatments may enhance each other, the potential placebo effect of experiencing all treatments offered in the study, and the possibility that ESI treatments "provide significant short-term pain relief that allows optimal participation in [physical therapy], which provides long-term benefit." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.