Our experience with epidural steroid injections in the management of low back pain and sciatica (original) (raw)
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Our experience with epidural steroid injections in management of low backpain and sciatica
2005
Background: Low back pain (LBP) and sciatica is a common clinical condition worldwide.The initial treatment of Low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a reliable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of ongoing study of the use of epidural steroid injection the management of low back pain cases coming to the orthopaedic department of Government Medical College Jammu. Methods: 150 Patients reporting with low back pain and sciatica not responding to other modes of conservative treatment were prospectively followed over a two year period. The caudal epidural steroid injections were performed, as many as three injections two week apart .The patients were assessed before and after the procedure clinically and the Level of pain, improvement in physical signs and ability to do activities of daily living were noted. Results:150 patients were observed for the duration of 2 years. Average duration of symptoms was for six months. After first epidural steroid injection 80% [120] of patients reported relief within first two weeks. Forty Four (44) patients required two injections and 12 patients required three injections. Twelve (12) patients reported no relief after first injection. The duration between two injections was two to three weeks. Average duration of pain relief was 17days. At the end of three months, good results were seen in 49%, fair in 32% and bad results in 18%. Overall 69% of patients were able to do activities of daily living. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. Conclusion: Epidural Steroid Injection is a simple, cost effective and minimally invasivemode of treatment of Low Back Pain and sciatica. It provides pain free period to enable the patient for physiotherapy which helps in early recovery.
Management of Low Back Pain by Administration of Epidural Steroid Injection
Innovative Publication, 2016
The likelihood of experiencing an episode of low back pain increases with age, and 85% of people will have at least one episode in their lifetime. Prevalence of low back pain is next only to headache. Total 50 patients (28 male and 22 female) who met the inclusion and exclusion criteria underwent epidural steroid injection. Patient pain scaling is done before performing the procedure, after 48 hours, after 2 weeks, after 3 months of the procedure. The proposed pain scale to be used is Numerical Rating Scale. Out of total 50 patients, after 48 hours it was found 30 patients had mild pain (NRS 1-3),18 patients moderate pain (NRS 4-6) and 2 patient continued to have severe pain (NRS 7-10). After 2 weeks it was found 24 patients to be mild pain, 24 patients with moderate pain and 2 patient with severe pain. After 3 months it was found 14 patients had mild pain, 32 patients had moderate pain and 4 patients had severe pain. The effect of epidural steroid injection decreases with time. The local effect of steroids has been shown to last at least 2 to 3 weeks at a therapeutic level. Epidural Steroid Injection is a safe, effective, & economical treatment modality for LBP. It reduces the period of hospitalization, analgesic intake & facilitates the institution of early rehabilitative programs.
Pain, 1995
The purpose of the study was to assess the efficacy of epidural steroid injections for low-back pain. Data was obtained using computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Twelve randomized clinical trials evaluating epidural steroid injections were identified. Data was extracted based on scores for quality of the methods, using 4 categories (study population, interventions, effect measurement, and data presentation and analysis) and the conclusion of the author(s) with regard to the efficacy of epidural steroid injections. Method scores of the trials ranged from 17 to 72 points (maximum 100 points). Eight trials showed method scores of 50 points or more. Of the 4 best studies (> 60 points), 2 reported positive outcomes and 2 reported negative results. Overall, 6 studies indicated that the epidural steroid injection was more effective than the reference treatment and 6 reported it to be no better or worse than the reference treatment. There appeared to be no relationship between the methodological quality of the trials and the reported outcomes. In conclusion, there are flaws in the design of most studies. The best studies showed inconsistent results of epidural steroid injections. The efficacy of epidural steroid injections has not yet been established. The benefits of epidural steroid injections, if any, seem to be of short duration only. Future research efforts are warranted, but more attention should be paid to the methods of the trials.
Role of caudal epidural steroid injections in the management of chronic low backache
IP innovative publication pvt. ltd, 2019
Introduction: Back pain especially in lumbar region has increased to epidemic proportions in general population. It may have associated radiculopathy. Conservative treatment is mainstay treatment for all eviating pain and radiculopathy. A dependable alternative is epidural steroid injection given in multiple doses. Materials and Methods: 50 Patients were treated with caudal epidural steroid injection for chronic low backache of more than three months at our institute. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day to day life and work performance on the basis of visual analogue scale and oswestry disability index. Results: Patients were followed for one year. They were categorized into excellent, good, fair and poor on the basis of pain alleviation and capability to work. We reported excellent 13, good 15, fair 12 and 10 poor results. Three patients required surgery for disc prolapse. Only complication reported was pain at epidural injection region. Conclusion: Epidural steroids are slowly proving to be a reliable alternative for all eviating pain and radiculopathy for a short term. It provides significant symptom free time for patients to receive physiotherapy that is crucial for early and adequate rehabilitation.
Revue du rhumatisme (English ed.), 1999
Several randomized trials have suggested recently that epidural steroid injections may not be a valid treatment in common low back pain and sciatica. To clarify this issue, we conducted a critical appraisal of relevant randomized trials published up to 1997. Attention was directed to methodological quality, results, and clinical implications. A Medline search identified 13 trials published between 1966 and 1997. Trial methodology was evaluated using a 100-point grid based on four groups of items, namely study population, therapeutic intervention, evaluation method, and data presentation and analysis. Methodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group. Eight trials found no measurable benefits. Obstacles to meaningful comparisons across studies included differences in the patient populations, steroid used...
Efficacy of Epidural Steriod for Chronic Low Back Ache
IOSR Journals , 2019
Introduction: Low back ache constitutes majority of the cases of orthopaedics out patient department. Low back ache causes more global disability than any other condition. Historically Epidural steroid injection is widely being used as nonspecific treatment for LBA with radiculopathy. The efficacy of epidural steroid is still controversial. Studies supporting the use and opposing the use are available. The rationale behind using epidural steroid is it anti-inflammatory action of steroid. Our study aims at observing the efficacy of epidural steroid injection for chronic lowback ache with radiculopathy and observing related complications during the procedure Methodology It is a prospective study. Patients who attended our out patient department between October 2017 and October 2018 who presented with chronic low back ache with radiculopathy were identified. All patients who met the inclusion criteria were included in the study. Patients were followed up for period of 6 months following the epidural steroid injection .Pre and post procedure pain relief was measured using visual analogue scale. The results were analysed Results92% of the cases their VAS score came down to 0-1.patients had significant relief from low back ache as well as radicular pain. 4 patients (8% of case) all are female patients had no significant relief with epidural steroid injection. All the 4 patients needed surgery for symptom relief. Conclusion Epidural steroid injection for low back ache with radiculopathy gave satisfactory results in 92% of cases at 6 months followup. The results are favourable for both low back ache and radiculopathy
Systematic review of therapeutic lumbar transforaminal epidural steroid injections
Pain physician
Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. The transforaminal route to the lumbar epidural space for steroid injection has gained rapid and widespread acceptance for the treatment of lumbar and leg pain. However, there are few well-designed randomized, controlled studies to determine the effectiveness of epidural injections. The role and value of transforaminal lumbar epidural steroid injections is still questioned. A systematic review of transforaminal epidural injection therapy for low back and lower extremity pain. To evaluate the effect of transforaminal lumbar epidural steroid injections in managing lumbar (low-back) and sciatica (leg) pain. The available literature of lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utiliz...
INTRODUCTION Lower back pain is one of the most common after headache. Along with lower back pain, radiating pain or radicular pain down to the lower limb is a widespread clinical problem that need be addressed precisely. Almost 30% of patients who develop lower back pain usually will suffer from radicular pain at one point of time. More than 50% of the patients with radiculopathy and sciatica have disturbances in performing activities of daily living and difficulty at work, leading to loss of work hours. The most common cause of lumbosacral radiculopathy in all the age group is intervertebral disc prolapse, and almost 10% to 15% of these patients eventually may require surgery due to their persistent symptoms, interference with daily activity, and neurological deficit. 1 However, majority of patients with lumbosacral radiculopathy have uneventful recovery with conservative management. The conservative management is wide and typically includes bed rest during acute ABSTRACT Background: Low back pain is a common entity with a lifetime prevalence of 65 to 80 percent in general population, and usually disrupts work, social activity and activity of daily living. The purpose of our study was to evaluate the results of interlaminar epidural steroid injection versus caudal steroid injection for patients of lower back pain with radiculopathy, due to disc prolapse or disc degeneration in terms of pain relief and complications. Methods: A total of 272 subjects having low back pain with radicular leg pain and MRI evidence of single or double level disc prolapse were chosen. Out of 272, patients were randomly assigned to two group; the first group having 131 patients and second group having 141 patients. The first group received caudal steroid injection, and second group received interlaminar epidural steroid under fluoroscopy control. Follow up for both groups was at 1 week, 6 weeks, and 12 weeks. Results: The change in pain scores were rated as mild, moderate and excellent. The interlaminar epidural steroid injection fared excellent in earlier follow up, getting to moderate at 12 weeks' time. The caudal steroid injection produced moderate relief in early phase at 12 weeks' time. Conclusions: The caudal steroid injection is cost effective, easy to administer and is having much less complications as compared to interlaminar steroid injection. Both these procedures are safe, well tolerated procedures, and can be performed as outpatient procedures