Steroids and L-Lysine Aescinate for Acute Radiculopathy Due to a Herniated Lumbar Disk

Abstract

Background and objectives. The efficacy of commonly prescribed analgesic and adjuvant drugs for the management of patients with radiculopathy has not been well established. Oral steroids are commonly used to treat sciatica or radiculopathy due to a herniated disk but the effect remains controversial. L-lysine aescinate showed superiority over placebo or baseline therapy with NSAIDs alone in treating sciatica, but have not been evaluated in an appropriately powered clinical trial. Materials and Methods. Randomized, double-blind clinical trial conducted in two health centers in collaboration with Uzhhorod Natioanl University in Ukraine. Adults (N = 90) with acute radicular pain and a herniated disk confirmed by MRI were eligible. Participants were randomly assigned to three groups (N = 30 in each) to receive a baseline therapy with lornoxicam (16 mg per day) and adjunctive 5-day course of IV dexamethasone (first group: 8 mg per day/40 mg total) or 0,1% solution of L-lysine aescinate (5 mL and 10 mL for group 2 and 3 respectively). Primary outcomes were Visual Analogue Scale changes and the straight leg raise angle at 15th and 30th day. Results. The level of pain improvement at 15th days after initiation of therapy with dexamethasone or solution of L-lysine aescinate at doses of 5 or 10 mL was not significantly different. The lowest levels of pain were achieved in patients who received the L-lysine aescinate 10 mL, but the range of decrease in pain was slightly greater in the group administered dexamethasone. Conclusions. Among patients with acute radiculopathy due to a herniated lumbar disk a short course of IV dexamethasone or L-lysine aescinate resulted in pain improvement at 15th and 30th day. Dexamethasone may be preferable if a longer-term analgesic effect is needed. Taking into account side effects of dexamethasone, a solution of L-lysine aescinate can be used to relieve pain symptoms.

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

“…56 The peripheral nerves may not have been properly blocked depending on the form of anesthesia that was used in the included studies. Lysine has shown to have an analgesic effect in patients with herniated lumbar disk 57 and thus, hypothetically, TXA may reduce pain originating from the periosteum and reduce neurogenic inflammation. Studies investigating if TXA had a dose-response relationship with inflammation overall showed that a higher dose of TXA results in lower levels of inflammatory biomarkers.…”

“…56 The peripheral nerves may not have been properly blocked depending on the form of anesthesia that was used in the included studies. Lysine has shown to have an analgesic effect in patients with herniated lumbar disk 57 and thus, hypothetically, TXA may reduce pain originating from the periosteum and reduce neurogenic inflammation.…”

Dexamethasone Suppresses Radicular Pain Through Targeting the L‐PGDS/PI3K/Akt Pathway in Rats With Lumbar Disc Herniation

“…Glucocorticoids like dexamethasone have been routinely used to treat LDH. Oros et al 34 reported that intravenous injection of dexamethasone produced a long‐term analgesic effect in patients with acute radiculopathy and sciatica. Tagowski et al 12 found that dexamethasone was more effective in alleviating LDH‐induced radicular pain compared to that triggered by fixed stenotic spinal lesions.…”

The Role of Systemic Steroids in Sciatica Due to Herniated Lumbar Disc

“…The deviations from intended interventions and missing outcome data domains were generally judged as low risk of bias. There were three studies [23][24][25] with high risk and one study 26 with some concerns due to inappropriate measurement of exposure. Nearly all studies (90%) were judged with high risk or some concerns of selective reporting.…”