November 28, 2012Volume 7 - Issue 48    

DynaMed Weekly Update

For the week ending November 23, 2012

Last week 288 articles were evaluated via DynaMed's Systematic Literature Surveillance and 172 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

For Patients with Sciatica, Epidural Corticosteroid Injections May Provide Small Short-Term Benefits for Leg Pain and Disability but No Differences in Outcomes at 1 Year


Epidural corticosteroid injection is a common treatment for leg and lower back pain when more conservative treatments are not effective. In light of the recent outbreak of fungal meningitis associated with contaminated steroid preparations, DynaMed editors decided to highlight a recent systematic review assessing the efficacy of epidural steroids for sciatica.


The systematic review compiled data from 23 randomized trials with 2,334 patients who had sciatica for at least 6 weeks to compare epidural corticosteroid injections to placebo. Corticosteroids included methylprednisolone, prednisone, prednisolone, triamcinolone, and betamethasone, and were administered by caudal, interlaminar, or transforaminal approaches. Because different scales were used across trials to assess pain and disability, all scores were converted to a 0-100 scale for analysis. The authors considered a reduction of at least 10 points in pain or disability to be clinically relevant, a threshold suggested by multiple sources.


At follow-up of up to 3 months, epidural steroids were associated with statistically significant reductions in mean leg pain (weighted mean reduction 6.2 points, 95% CI 3-9.4 in analysis of 14 trials with 1,316 patients) and mean disability score (weight mean reduction 3.1 points, 95% CI 1.2-5 in analysis of 10 trials with 1,154 patients) (level 2 [mid-level] evidence). Neither of these short-term improvements reached the threshold for clinical significance. Due to the nature of the data available from the original trials, the review did not analyze any dichotomous outcomes (e.g. proportion of patients with at least 30% pain reduction), so these analyses may not exclude the possibility of significant benefit in some subpopulations. 


There were no significant differences in either leg pain or disability at 12 months follow-up. Low back pain was not significantly reduced in the steroid group at either 3 months or 12 months follow-up (Ann Intern Med 2012 Dec 18;157(12):865).


For more information, see the Sciatica topic in DynaMed.

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DynaMed Events  

American Society of Hematology (ASH) Annual Meeting and Exposition, December 8th - 11th, 2012


Senior Deputy Editor Alan Ehrlich will be attending the American Society of Hematology Annual Meeting and Exposition held at the Georgia World Congress Center in Atlanta, Georgia. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.


Visit the American Society of Hematology's website to learn more about the event and for registration information.

Call for Peer Reviewers

We are currently seeking reviewers for:   

Lumbar disc herniation 

Mucopolysaccharidosis type I (MPS I) 

Learn more about the DynaMed Contribution Opportunities:

DynaMed Peer Review 

Editorial Policies for Reviewers 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: November 28, 2012
Expiration Date: November 28, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives


Upon successful completion of this educational program, the reader should be able to:


1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.


Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.


Program ID: 1210392M

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