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Systematic review with meta analysis
Appropriate design, methodological quality assessment, and clinically relevant outcomes are essential to determine the therapeutic role of epidural injections for low back pain and radiculopathy
  1. Mark V Boswell1,
  2. Laxmaiah Manchikanti2,3
  1. 1Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA;
  2. 2Pain Management Center of Paducah, Paducah, Kentucky, USA;
  3. 3University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to : Dr Mark V Boswell, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 S Jackson Street, Room C2A01, Louisville, KY 40202, USA; boswellmv{at}; mark.boswell{at}

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Epidural injections with local anaesthetics have been performed since 1901, and with corticosteroids since 1952. The use of epidural injections in clinical practice continues to increase.1–4 Despite multiple randomised controlled trials, systematic reviews, and clinical guidelines, there are conflicting and discordant recommendations regarding their use,3 ,4 with some high profile publications reporting a lack of efficacy,5 including the systematic review and meta-analysis discussed here.


Chou and colleagues performed a systematic review of randomised controlled trials of …

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  • Competing interests LM has provided limited consulting services to Semnur Pharmaceuticals, Incorporated, which is developing non-particulate steroids.

  • Provenance and peer review Commissioned; internally peer reviewed.