Letters Treatment of lumbosacral radicular pain

Comparative efficacy trials with no placebo group cannot determine efficacy

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3292 (Published 24 June 2015) Cite this as: BMJ 2015;350:h3292
  1. Chung-Wei Christine Lin, senior research fellow and associate professor1,
  2. Richard O Day, professor of clinical pharmacology2,
  3. Ian Harris, professor of orthopaedic surgery 3,
  4. Chris G Maher, professor 1,
  5. Andrew McLachlan, professor of pharmacy4
  1. 1George Institute for Global Health and Sydney Medical School, University of Sydney, Sydney NSW 2000, Australia
  2. 2St Vincent’s Hospital Clinical School and Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, NSW, Australia
  3. 3South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales
  4. 4Faculty of Pharmacy and Centre for Education and Research on Ageing, University of Sydney
  1. clin{at}george.org.au

Cohen and colleagues’ trial of epidural steroids versus gabapentin in patients with lumbosacral radicular pain found no significant difference in the primary outcome.1 There are several problems with their conclusion that a trial with neuropathic drugs might be a first line treatment option.

Given the lack of a difference between treatment groups, there was no justification for endorsing one treatment over the other. In addition, the trial did not study first line treatment. All …

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