Analgesic efficacy of oral gabapentin added to standard epidural corticosteroids in patients with failed back surgery

Abstract

ObjectiveFailed back surgery syndrome is characterized by the presence of intractable pain and varying degrees of functional incapacity after lumbar spine surgery. Because the mechanisms that cause pain are variable, treatment of this syndrome is quite difficult, and one of the most common methods that is used for treatment nowadays is epidural injection. This research evaluates the analgesic efficacy of addition of oral gabapentin treatment to epidural corticosteroid application in patients with failed back surgery syndromes.MethodsForty-two patients, including 23 females and 19 males, with failed back surgery syndrome who had been previously operated on at least twice due to lumbar disc herniation were randomly divided into two groups. Following epidural application of a single dose of methylprednisolone in the first group of patients (Group K), an oral medical treatment containing naproxen sodium, tizanidine, and vitamin B and C complex, was devised to be applied for one month. For the second group, oral gabapentin was added to the same treatment regime (Group G). Pain levels were evaluated by a visual analog scale for straight leg raise before, during, and after treatment, as well as in the first and third months.ResultsThere was no demographically significant difference between the patients (P > 0.05). After the beginning of treatment, it was observed that the pain level in Group G patients regressed earlier and that it progressed at a significantly lower level (both in the first and third month controls).ConclusionIt was concluded that addition of oral gabapentin to epidural corticosteroid application in patients with failed back surgery syndromes was effective in ameliorating pain at an early stage without significant side effects.

Failed back surgery syndrome: current perspectives

“…Zencirci et al54 demonstrated that adding Gabapentin to ESI in patients with FBSS from at least two prior surgeries for lumbar disc herniation had significantly lower pain levels at 1 and 3 months compared with those who received ESI while taking naproxen sodium, tizanidine, and vitamin B and C complex 54. This study underlies the importance of a multimodal approach to treating FBSS.…”

Systematic review of management of chronic pain after surgery

“…An 8‐week course of gabapentin was found to be superior to a stellate ganglion block using bupivacaine in a trial involving 60 patients after mastectomy. The addition of 1 month of oral gabapentin to standard epidural corticosteroids was found to result in lower pain at 6 months compared with epidural corticosteroids alone after spinal surgery.…”

“…Eight trials including data from 338 participants evaluated the effects of antiepileptic medications on CPSP. The largest number of studies for any one technology was for gabapentin (6 studies, 293 participants with pain after amputation, breast cancer surgery, sternotomy and spinal surgery). Four trials were at risk of bias owing to issues relating to blinding, blinding and randomization, incomplete outcome data, and blinding and single‐authored article.…”

“…The largest number of studies for any one technology was for gabapentin (6 studies, 293 participants with pain after amputation, breast cancer surgery, sternotomy and spinal surgery). Four trials were at risk of bias owing to issues relating to blinding, blinding and randomization, incomplete outcome data, and blinding and single‐authored article. Meta‐analysis using the generic inverse‐variance method was possible for the primary outcome for one subgroup only (gabapentin versus placebo for 6 weeks) involving two crossover trials with 43 patients.…”

Therapeutic Interventional Procedures following Failed Back Surgery; Is It Worth it?

“…3 FBSS can be defined as persistent or recurring low back pain, with or without sciatica following one or more lumbar surgeries. 35 The rate of the FBSS increased in the last two decades despite of the advances in surgical technology. 14,22 A recent systemic literature review of discectomies for lumbar disc herniation demonstrates that 5%-36% of patients after 2 years had FBSS below the age of 70 years.…”