***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To determine the efficacy of epidural corticosteroid injections for sciatica . Methods : Three epidural injections ( two day intervals ) of 2 ml prednisolone acetate ( 50 mg ) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15–180 days .  Self evaluation was the main judgment criterion at day 20 . Patients who recovered or showed marked improvement were considered as success . Pain measured by VAS , the SLR test , Schober ’s test , Dallas pain question naire , and the Rol and -Morris index were evaluated at days 0 , 5 , 20 , and 35 . Only analgesics were authorised , patients requiring non-steroidal anti-inflammatory drugs ( NSAIDs ) before day 20 were considered as failure . Results : 42 patients were included in the control group ( CG ) , 43 in the steroid group ( SG ) . On an intention to treat analysis 15/42 ( 36 % ) in the CG and 22/43 ( 51 % ) in the SG ( p=0.15 ) were considered as success ( difference 15.5 % , 95 % CI ( −5.4 to 36.3 ) ) . Among the 48 failures , 14 patients ( 6 CG , 8 SG ) required NSAIDs , 3 ( 2 CG , 1 SG ) required surgery , and 7 ( 3 CG , 4 SG ) other treatments . On analysis according to protocol , in 74 remaining patients 12/35 ( 34 % ) in the CG and 22/39 ( 56 % ) in the SG ( p=0.057 ) were considered as success ( difference 22.1 % , 95 % CI ( 0.0 to 44.2 ) ) . For all secondary end points intragroup improvement with time was significant , but intergroup differences were not . Conclusion : The efficacy of isotonic saline administered epidurally for sciatica can not be excluded , but epidural steroid injections provide no additional improvement The management of sciatica due to lumbar nerve root compromise remains controversial , probably because few well-controlled studies of conservative management have been performed . This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5 % procaine hydrochloride in saline , administered via the caudal route , in a double-blind , placebo controlled trial with 1 year follow-up . Twenty-three patients were entered into the study : 12 received treatment and 11 placebo .  The active group showed significant pain relief ( P=0.02 ) and a significant increase in mobility ( P=0.01 ) at 4 weeks , which result ed in improved quality of life ( P=0.02 ) . At 1 year , subjective and objective measures improved in both groups . The improvement was greater in the actively treated group , but only the objective assessment ( straight leg raise ) was statistically significant BACKGROUND Although epidural corticosteroid injections are commonly used for sciatica , their efficacy has not been established . METHODS In a r and omized , double-blind trial , we administered up to three epidural injections of methylprednisolone acetate ( 80 mg in 8 ml of isotonic saline ) or isotonic saline ( 1 ml ) to 158 patients with sciatica due to a herniated nucleus pulposus . All patients had Oswestry disability scores higher than 20 ( on a scale of 1 to 100 , with scores of 20 or less indicating minimal disability , and higher scores greater disability ) . RESULTS At three weeks , the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group ( 95 percent confidence interval for the difference , -7.1 to 2.2 ) . Differences in improvements between the groups were not significant , except for improvements in the finger-to-floor distance ( P=0.006 ) and sensory deficits ( P=0.03 ) , which were greater in the methylprednisolone group . After six weeks , the only significant difference was the improvement in leg pain , which was greater in the methylprednisolone group ( P=0.03 ) . After three months , there were no significant differences between the groups . The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group ( 95 percent confidence interval for the difference , -9.3 to 5.4 ) . At 12 months , the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group ( P=0.90 ) . CONCLUSIONS Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus , this treatment offers no significant functional benefit , nor does it reduce the need for surgery The value of epidural injections of corticosteroid as an outpatient treatment of sciatica has been hitherto uncertain . An epidural injection of 80 mg methylprednisolone in 10 ml physiological saline was compared with an interspinous injection of 2 ml physiological saline in a double blind fashion amongst 39 out patients . Significant differences of pain relief were seen between the two groups within 2 weeks . This benefit disappeared for six ( 35 % ) patients within 6 months of treatment although 11 ( 65 % ) successfully treated subjects had sustained improvement up to this time . Outpatient epidural injections of corticosteroid are thus a useful short-term means of relieving pain in sciatica but probably have little effect on the long-term natural history of symptoms . Factors associated with a failure to respond to epidural steroid injections are discussed OBJECTIVE To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections ( ESI ) in patients with sciatica . We performed a 12-month , multicentre , double-blind , r and omized , placebo-controlled , parallel-group trial in four secondary pain-care clinics in the Wessex Region . METHODS Two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica of 1 - 18 months ' duration were r and omized to either three lumbar ESIs of triamcinolone acetonide or interligamentous saline injections at intervals of 3 weeks . The main outcome measure was the Oswestry low back pain disability question naire ( ODQ ) . RESULTS At 3 weeks , the ESI group demonstrated a transient benefit over the placebo group ( patients achieving a 75 % improvement in ODQ , 12.5 vs 3.7 % ; number needed to treat , 11.4 ) . No benefit was demonstrated from 6 to 52 weeks . ESIs did not improve physical function , hasten return to work or reduce the need for surgery . There was no benefit of repeated ESIs over single injection . No clinical predictors of response were found . At the end of the study the majority of patients still had significant pain and disability regardless of intervention . CONCLUSIONS In this pragmatic study , ESIs offered transient benefit in symptoms at 3 weeks in patients with sciatica , but no sustained benefits in terms of pain , function or need for surgery . Sciatica is a chronic condition requiring a multidisciplinary approach . To fully investigate the value of ESIs , they need to be evaluated as part of a multidisciplinary approach OBJECTIVE To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections ( ESIs ) and conservative management in patients with lumbar radiculopathy . STUDY DESIGN Quasi-experimental study . PLACE AND DURATION OF STUDY The Postgraduate Medical Institute of Hayatabad Medical Complex , Peshawar , from April 2005 to March 2007 . METHODOLOGY Fifty elective patients fulfilling the inclusion criteria were r and omly divided into two groups . Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2 % plain xylocaine and 3 ml of normal saline in the lumbar epidural space , while patients in the conservative group were treated with bed rest , non-steroidal anti-inflammatory agents , muscle relaxants , and opioids . All the 50 patients in the two groups were regularly assessed at 2 weeks , 1 month , 3 months and 6 months of periods for pain score by the Visual Analogue Scale ( VAS ) , patients satisfaction score and any unwanted side effects . RESULTS A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group . Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month ( p < 0.05 ) . The difference in Visual Analogue Scale ( VAS ) and patients satisfaction score was non-significant in chronic stages of treatment in both groups ( p > 0.05 ) . CONCLUSION Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment OBJECTIVE Low back pain is a highly common problem and causes much morbidity and socioeconomic loss in the community . Although the use of caudal epidural injections in the management of the low back pain with radicular signs is commonplace , it has not been well investigated . We compare the effectiveness of caudal epidural injection versus non-steroidal anti-inflammatory drugs ( NSAIDs ) in the treatment of low back pain accompanied with radicular pain . METHODS The study was a controlled prospect i ve unblinded trial . A total of consecutive 64 patients with subacute or chronic low back pain accompanied with radicular pain were included . The patients were r and omly allocated to two groups . First group was caudal epidural injection plus therapeutic exercise group , and the second group was NSAIDs plus therapeutic exercise group . Patients were assessed with 10 cm visual analogue scale for pain , straight leg raising test and Oswestry low back pain disability question naire at the beginning and at 15th day , 1st and 3rd month . RESULTS It was seen that both groups ' improvement were good and statistically significant . On the other h and , caudal epidural injection group 's improvement was better and faster than the NSAID group 's , and the differences between assessment scores of the groups were statistically significant , except the 3rd month Oswestry scores . CONCLUSION Finally , caudal epidural injection in the management of the subacute/chronic low back and radicular pain is a preferable choice , if applied by experienced specialists Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear Study Design . A subgroup analysis of a prospect i ve , r and omized controlled trial was performed . Objective . To describe the cost effectiveness of periradicular infiltration with steroid in subgroups of patients with sciatica . Summary of Background Data . A recent trial on periradicular infiltration indicated that a methylprednisolone – bupivacaine combination had a short-term effect , as compared with that of saline . This report describes the efficacy and cost effectiveness of steroid in subgroups of patients with sciatic . Methods . This study involved 160 patients with unilateral sciatica . Outcome assessment s were leg pain ( 100-mm visual analog scale ) , disability on the Oswestry Low Back Disability Question naire , and the Nottingham Health Profile . Data on medical costs and sick leaves also were gathered . Patients were r and omized for periradicular infiltration with either methylprednisolone – bupivacaine or saline . The adjusted between-group treatment differences at each follow-up assessment , the number of patients free of leg pain ( responders , cutoff 75 % ) , and efficacy by the area-under-the-curve method were calculated . For the cost-effectiveness estimate , the total costs were divided by the number of responders . The rate of operations in different subgroups was evaluated by Kaplan-Meier analysis . Results . In the case of contained herniations , the steroid injection produced significant treatment effects and short-term efficacy in leg pain and in Nottingham Health Profile emotional reactions . For symptomatic lesions at L3–L4–L5 , steroid was superior to saline for leg pain , disability , and straight leg raising in the short term . By 1 year , steroid seemed to have prevented operations for contained herniations , costing $ 12,666 less per responder in the steroid group ( P < 0.01 ) . For extrusions , steroid seemed to increase the operation rate , and the steroid infiltration was more expensive , costing $ 4445 per responder ( P < 0.01 ) . Conclusions . In addition to short-term effectiveness for contained herniations and lesions at L3–L4–L5 , steroid treatment also prevented surgery for contained herniations . However , steroid was countereffective for extrusions . The results of the subgroup analyses call for a verification study Study Design . A r and omized , double-blind controlled trial . Objectives . To determine the treatment effect of corticosteroids in periradicular infiltration for chronic radicular pain . We also examined prognostic factors in relation to the outcome of the procedure . Summary of Background Data . Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anesthetic and cortic 
    Output:
    
All-cause mortality was low in our analysis of patients attending specialty clinics .
In terms of spinal steroid injections , headache appeared to be the most common adverse effect .
Oral opioid therapy may be helpful for the treatment of low back pain , but it is unclear from the high- quality literature whether there are limitations from adverse effects .
Spinal steroid injections are beneficial for low back pain and disability in the short-term .
The high dropout rates caused by insufficient pain relief and adverse effects suggest that opioids may not be as effective as spinal steroid injections .
There is more high- quality literature to support the use of spinal steroid injections compared with oral opioids in this condition