Affiliation:
1. Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY
Abstract
Background: Low back pain without disc herniation is the most common problem among chronic
pain disorders. Epidural injections are commonly used interventions in managing chronic low back
pain without disc herniation. However, little evidence exists regarding the effectiveness, indications,
and medical necessity of lumbar epidural injections in managing axial low back pain without disc
herniation or radiculitis.
Study Design: A randomized, double-blind, controlled trial.
Setting: An interventional pain management practice, a specialty referral center, a private practice
setting in the United States.
Objectives: To evaluate the ability to provide effective and long-lasting pain relief with lumbar
interlaminar epidural injections with local anesthetic with or without steroids in managing chronic
low back pain not caused by disc herniation or radiculitis.
Methods: Patients were randomly assigned to one of 2 groups with Group I patients receiving
local anesthetic only, whereas Group II patients received local anesthetic mixed with non-particulate
betamethasone. Seventy patients were included in this analysis. Randomization was performed by
computer-generated random allocation sequence by simple randomization.
Outcomes Assessment: Outcome measures included the Numeric Rating Scale (NRS), the
Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake. The assessments were
done at baseline, 3 months, 6 months, and 12 months post-treatment.
Significant pain relief and/or improvement in disability were defined as at least 50% improvement.
Results: Significant pain relief (≥ 50%) was demonstrated in 74% of patients in Group I and 63%
in Group II. Functional status improvement (reduction of ≥ 50%) in the ODI scores was seen in 71%
of patients in Group I and 60% of patients in Group II. The overall average procedures per year were
approximately 4.
Limitations: The results of this study are limited by the lack of a placebo group and that it is a
preliminary report of 35 patients in each group with a total of 70 patients.
Conclusion: Lumbar interlaminar epidural injections of local anesthetic with or without steroids
was effective in 63% and 74% of patients with chronic function-limiting low back pain without
facet joint pain, disc herniation, and/or radiculitis.
Key words: Chronic low back pain, lumbar interlaminar epidural injections, discogenic pain, disc
herniation, radiculitis, local anesthetic, steroids, controlled comparative local anesthetic blocks
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
10 articles.
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