Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome

Abstract

Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

“…The Cochrane review included six pragmatic trials that reported on short-term pain relief [8,22,38,63,77,78]. Four of these six trials showed a non-significant positive effect of corticosteroids compared to other procedures.…”

Failed back surgery syndrome: casuistic and etiology

“…Other therapeutical possibilities include the spinal dorsal stimulation whose results depends on the correct election of the patient, being those with arachnoiditis the most studied 21,22 . Epidural injections and injections on the nervous roots had been also very studied and they do not present good results 23,24 . A study defends the preoperative irradiation for reoperation after epidural fibrosis with favorable results 25 , as also exist experiments with synthetic materials for the prevention of fibrosis 26,27 .…”

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion

“…At this time point, the morphine plus steroid group had superior pain relief compared with the saline plus steroid group. Rocco, et al, 56 published a randomized, double-blind study in which 22 patients with chronic low-back pain resulting from postlaminectomy syndrome were examined. In their study, all patients received 50 mg lidocaine epidurally and were randomly assigned to receive 75 mg triamcinolone diacetate, 8 mg morphine, or both, in addition to the lidocaine.…”