The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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A Comparison of the Efficacy of Epidural Steroid Injections in Terms of the Dosages and Frequency of Triancinolone Injections for the Pain Related to Lumbar Spinal Stenosis or Herniated Disks

요추 추간판 탈출증과 척주관 협착에 의한 통증 치료에 Triamcinolone 시술 횟수와 용량에 따른 경막외 스테로이드 주입법의 효과 비교

  • Hwang, Byeong Moon (Department of Anesthesiology and Pain Medicine, Kangwon National University Medical School) ;
  • Hwang, Bum Sang (Department of Anesthesiology and Pain Medicine, Kangwon National University Medical School)
  • 황병문 (강원대학교 의과대학 마취통증의학교실) ;
  • 황범상 (강원대학교 의과대학 마취통증의학교실)
  • Received : 2005.12.22
  • Accepted : 2006.04.21
  • Published : 2006.06.30
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Abstract

Background: The objective of this study was to describe the extent of pain relief after an epidural steroid injection in the patients suffering from chronic low back pain from herniated disks or lumbar spinal stenosis. Methods: The study was prospectively designed for patients suffering with lumbar spinal stenosis (LSS) and herniated disks (HD) who were referred to a hospital-based pain clinic for epidural steroid injections (ESI). The pain was assessed with using a visual analog scale at baseline, two weeks after the first ESI and two weeks after the third ESI. Results: Eighty patients were enrolled, and all of them provided pain ratings before and after the injections. The LSS patients seemed to improve less than did the HD patients. The results showed no significant differences in the triamcinolone dosage and the frequency of injections for determining the efficacy of ESI. Conclusions: The LSS patients tended to have a less effective respond to ESIs than did the HD patients. The unsatisfactory response to ESI by the LSS patients underscores the need for randomized controlled trials of performing ESI in this population.

Keywords

References

  1. Kim HS, Choi JW, Chang SH, Lee KS, Oh JY: Treatment duration and cost of work-related low back pain in Korea. J Korean Med Sci 2005; 20: 127-31 https://doi.org/10.3346/jkms.2005.20.1.127
  2. Abenhaim L, Suissa S: Importance and economic burden of occupational back pain: a study of 2,500 cases representative of Quebec. J Occup Med 1987; 29: 670-4
  3. Pai S, Sundaram LJ: Low back pain: an economic assessment in the United States. Orthop Clin North Am 2004; 35: 1-5 https://doi.org/10.1016/S0030-5898(03)00101-9
  4. Eriksen W: The prevalence of musculoskeletal pain in Norwegian nurses' aides. Int Arch Occup Environ Health 2003; 76: 625-30 https://doi.org/10.1007/s00420-003-0453-6
  5. White AH, Derby R, Wynne G: Epidural injections for the diagnosis and treatment of low back pain. Spine 1980; 5: 78-86 https://doi.org/10.1097/00007632-198001000-00014
  6. Benzon HT: Epidural steroids. In: Pain medicine, a comprehensive review. Edited by Raj PR: St. Louis, Mosby-Year Book. 1996, pp 259-64
  7. Karz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, et al: Degenerative lumbar spinal stenosis: diagnostic value of the history and physical examination. Arthritis Rheum 1995; 38: 1236-41 https://doi.org/10.1002/art.1780380910
  8. Borensrein D: Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol 1998; 10: 104-9 https://doi.org/10.1097/00002281-199803000-00003
  9. Scheet SJ, Radack KL, O'Brien DR: Randomized controlled trials in industrial low back pain relating to return to work. Parr I. Acute interventions. Arch Phys Med Rehabil 1995; 76: 966-73 https://doi.org/10.1016/S0003-9993(95)80076-X
  10. Raj PP: Practical management of pain. 3rd ed. St. Louis, Mosby Inc. 2000, pp 732-43
  11. Koes BW, Scholten RJ, Mens JM, Bouter LM: Efficacy of epidural steroid injections for low back pain and sciatica: a systemic review of randomized clinical trials. Pain 1995; 63: 279-88 https://doi.org/10.1016/0304-3959(95)00124-7
  12. Bowman SJ, Wedderburn L, Whaley A: Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine 1993; 18: 1345-50 https://doi.org/10.1097/00007632-199308000-00014
  13. Andersen KH, Mosdal C: Epidural application of corticosteroids in low back pain and sciatica. Acta Neurochir 1987; 87: 52-3 https://doi.org/10.1007/BF02076016
  14. Hopwood MB, Abram SE: Factors associated with failure of lumbar epidural steroids. Reg Anesth 1993; 18: 238-43
  15. Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pikens GT: The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized double-blind study. J Bone Joint Surg Am 1985; 67: 63-6 https://doi.org/10.2106/00004623-198567010-00009
  16. Jeon BY, Ryu SJ, Jang TH, Kim SH, Kang SH, Chung HS: The effects of selective spinal netve toot steroid injection for low back pain and radicular pain in patients with intervertebral disk herniation or spinal stenosis. Korean J Anesthesiol 1997; 32: 110-5 https://doi.org/10.4097/kjae.1997.32.1.110
  17. Carrette S, LeClaire R, Marcoux S, Morin F, Blaise GA, St. Pierre A, et al: Epidural corticosteroid injections fot sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336:1634-40 https://doi.org/10.1056/NEJM199706053362303
  18. Spaccarell KC: Lumbar and caudal epidural corticosteroid injections. Mayo Clin Proc 1996; 71: 169-78
  19. Hoogmartens M, Morelle P: Epidural injection in the treatment of spinal stenosis. Acta Orthop Belg 1987; 53: 409-11
  20. Delport EG: Treatment of Lumbar spinal stenosis with epidutal steroid injections: a tetrospective outcome study. Arch Phys Med Rehabil 2004; 85: 479-84 https://doi.org/10.1016/S0003-9993(03)00472-6
  21. Rivest C, Katz JN, Ferrante FM, Jamison RN: Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study. Arthritis Care Res 1998; 11: 291-7 https://doi.org/10.1002/art.1790110410
  22. Kepes ER, Duncalf D: Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review. Pain 1985; 22: 33-47 https://doi.org/10.1016/0304-3959(85)90146-0