Lumbar Transforaminal Epidural Steroid Injection in Patients with Lumbar Radicular Pain; Outcome Results of 2-Year Follow-Up

Hashemi, Masoud; Dadkhah, Payman; Taheri, Mohammad; Ghasemi, Mahshid; Hosseinpour, Ali

doi:10.29252/beat-070209

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Although mixed, some studies suggest that ESI may reduce opioid use in the short term. 79 , 80 Although no corticosteroids have received FDA approval for epidural injection, numerous studies over the past 50 years have demonstrated efficacy and safety leading to high utilization in treating lumbosacral radiculopathy. Overall, complication rates are low, with vasovagal reactions, increased radicular pain, and pain at the injection site being the most common.…”

Section: Discussionmentioning

confidence: 99%

“…ESIs play an integral role as part of a multimodal treatment strategy to treat lumbar and cervical radicular pain and theoretically present fewer risks than surgical interventions. Although mixed, some studies suggest that ESI may reduce opioid use in the short term 79,80. Although no corticosteroids have received FDA approval for epidural injection, numerous studies over the past 50 years have demonstrated efficacy and safety leading to high utilization in treating lumbosacral radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

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Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

Cohen

Greuber²,

Vought³

et al. 2021

The Clinical Journal of Pain

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Objective: Epidural steroid injections (ESIs) are a commonly utilized treatment for lumbosacral radicular pain caused by intervertebral disc herniation or stenosis. Although effective in certain patient populations, ESIs have been associated with serious complications, including paralysis and death. In 2014, the US Food and Drug Administration (FDA) issued a safety warning on the risk of injecting corticosteroids into the epidural space. The aims of this article were to review the neurological complications associated with ESIs and to compare the formulations, safety, and effectiveness of commercially available corticosteroids given by transforaminal, interlaminar, or caudal injection. Methods: Serious adverse events associated with ESIs were identified by a search of the FDA Adverse Event Reporting System (FAERS) database. A MEDLINE search of the literature was conducted to identify clinical trials comparing the safety and effectiveness of nonparticulate and particulate corticosteroid formulations. Results: Neurological complications with ESIs were rare and more often associated with the use of particulate corticosteroids administered by transforaminal injection. Among the 10 comparative-effectiveness studies reviewed, 7 found nonparticulate steroids had comparable efficacy to particulate steroids, and 3 studies suggested reduced efficacy or shorter duration of effect for nonparticulate steroids. Discussion: The risk of complications for transforaminal ESI is greater with particulate corticosteroids. Nonparticulate corticosteroids, which are often recommended as first-line therapy, may have a short duration of effect, and many commercial formulations contain neurotoxic preservatives. The safety profile of ESIs may continue to improve with the development of safer, sterile formulations that reduce the risk of complications while maintaining efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

Cohen

Greuber²,

Vought³

et al. 2021

The Clinical Journal of Pain

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“…[330][331][332] Epidural steroids are effective in reducing pain severity, decreasing opioid use, improving function, avoiding the need for surgery, and even treating pain in patients who have not responded to surgical intervention. 329,[333][334][335][336][337] Steroids may exert anti-inflammatory effects on the neuroimmune interface. Consistently with preclinical models, steroid administration (local, intrathecal, or systemic administration) before or at the time of injury reduces proinflammatory cytokines, neuronal firing rates, glial cell activation in the spinal cord, and correlates with a reduction in pain behavior after nerve injury.…”

Section: Steroids and Neuro-immune Interfacementioning

confidence: 99%

The Role of Neuro-Immune Interactions in Chronic Pain: Implications for Clinical Practice

Su¹,

Zhang²,

He³

et al. 2022

JPR

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Chronic pain remains a public health problem and contributes to the ongoing opioid epidemic. Current pain management therapies still leave many patients with poorly controlled pain, thus new or improved treatments are desperately needed. One major challenge in pain research is the translation of preclinical findings into effective clinical practice. The local neuroimmune interface plays an important role in the initiation and maintenance of chronic pain and is therefore a promising target for novel therapeutic development. Neurons interface with immune and immunocompetent cells in many distinct microenvironments along the nociceptive circuitry. The local neuroimmune interface can modulate the activity and property of the neurons to affect peripheral and central sensitization. In this review, we highlight a specific subset of many neuroimmune interfaces. In the central nervous system, we examine the interface between neurons and microglia, astrocytes, and T lymphocytes. In the periphery, we profile the interface between neurons in the dorsal root ganglion with T lymphocytes, satellite glial cells, and macrophages. To bridge the gap between preclinical research and clinical practice, we review the preclinical studies of each neuroimmune interface, discuss current clinical treatments in pain medicine that may exert its action at the neuroimmune interface, and highlight opportunities for future clinical research efforts.

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“…It is associated with the significant disability. [3][4] It was observed in literature that transforaminal route of epidural injection for management of pain of lumbar region can be more helpful in resolution of pain. But not much work was done in this regard and conservative management was still in practice.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Transforaminal Epidural Injections in Patients with Lumbar Radicular Pain

Munir¹,

Rahim²,

Rahim³

et al. 2021

PJMHS

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Background: Backache is quite a common problem in adults.one of the common reasons for this is compression on nerve roots due to disc bulge. The pain may start from back and radiate to legs. Objective: The study aimed to evaluate the efficacy of corticosteroids when injected by transforaminal route. Study design: This descriptive study was conducted at Orthopedic Unit 2 Mayo Hospital Lahore. The duration of the study was six months from January 2018 to June 2018. Material and Methods: The study was conducted on the 127 patients attended the orthopedic department of our institute hospital. The ethical and review board committee of the hospital approved the study. Every participant was informed about the study and they willingly signed the written consent. According to the inclusion criteria the patients of age above than 18 diagnosed with the lumber pain. The 127 patients of both genders that were included in the study were given transforaminal epidural injections (TEI). The results were studied after 4 weeks. The pain reduction was scored using Oswesrty Disability Index (ODI). The age range of the patients included in the study was from 20 to 80 years. SPSS 5 was used for statistics analysis of the data collected. Results: The calculated mean ODI of patients at the start was 73.90+ and after four weeks it was reduced to 27.62-+8.66. The mean ODI score at baseline of the patients was 73.90±7.64 with lowest and highest value of 46 & 94 respectively. The average ODI score at 4th week of the patients was 27.62±8.66 with lowest and highest values of 10 & 60. The study results showed that the average reduction of ODI from baseline to 4th week of the patients was 46.29± 10.98 with lowest and highest reduction of 20 & 68. Conclusion: This study concluded that a significant reduction in mean pain score was noted with transforaminal Injections in patients with lumbar radical pain. It can be recommended to be used in patients with lumbar radical pain. The pain reduction was statistical significant after TEI. Keywords: Transforaminal epidural injection, Oswesrty score, lumbar radicular pain.

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Lumbar Transforaminal Epidural Steroid Injection in Patients with Lumbar Radicular Pain; Outcome Results of 2-Year Follow-Up

Cited by 8 publications

References 17 publications

Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

The Role of Neuro-Immune Interactions in Chronic Pain: Implications for Clinical Practice

Outcome of Transforaminal Epidural Injections in Patients with Lumbar Radicular Pain

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