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Papers of the Week

Papers: 2 Jan 2021 - 8 Jan 2021


2021 Jan

Pain Physician



Is Epidural Injection of Sodium Chloride Solution a True Placebo or an Active Control Agent? A Systematic Review and Meta-Analysis.


Manchikanti L, Knezevic N N, Sanapati J, Kaye AD, Sanapati MR, Hirsch JA
Pain Physician. 2021 Jan; 24(1):41-59.
PMID: 33400427.


Epidural injections have been extensively used since their description in 1901, and steroids since their first utilization in 1952. Multiple randomized controlled trials and systematic reviews have reached discordant conclusions regarding the effectiveness of sodium chloride solution and steroids in managing spinal pain. True placebo-controlled trials with the injection of an inactive substance to unrelated structures have been nonexistent. Consequently, the discussions continue to escalate, seemingly without proper discourse. In this review, we sought to assess the true placebo nature of saline and the effectiveness of steroids.