Infectious Risks of Chronic Pain Treatments: Injection Therapy, Surgical Implants, and Intradiscal Techniques

Rathmell, James P.; Lake, Tiffini; Ramundo, Mary B.

doi:10.1016/j.rapm.2006.03.004

Cited by 36 publications

(34 citation statements)

References 29 publications

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“…While waiting for cultures, treatment with antibiotics that cover S. aureus and Staphylococcus epidermidis is appropriate, as these are the most commonly isolated organisms. 294 …”

Section: Infectious Complicationsmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

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Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

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“…While waiting for cultures, treatment with antibiotics that cover S. aureus and Staphylococcus epidermidis is appropriate, as these are the most commonly isolated organisms. 294 …”

Section: Infectious Complicationsmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

View full text Add to dashboard Cite

show abstract

“…While the risk of life-threatening infection from SCS is rare [30], certain populations have been identified to be at an increased risk for surgical site infections. These include diabetics, smokers, the obese, the immunocompromised, and patients with rheumatoid arthritis [31][32][33][34].…”

Section: Infectionmentioning

confidence: 99%

Spinal Cord Stimulation: A Review

Compton¹,

Shah

Hayek

2011

Curr Pain Headache Rep

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Spinal cord stimulation (SCS) is a safe and effective treatment of a variety of chronic pain conditions. As our understanding of the mechanisms of action and potential uses of SCS has evolved, clinical and technological advancements have followed. This review provides an overview of potential mechanisms of action of SCS, evidence for its effectiveness, potential complications, and highlights of developing areas of interest.

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“…Every time the integumentary system is compromised, there is a risk of infection, and each tissue plane disrupted by the epidural needle (see above) is one at risk. Inadvertent dural puncture has resulted in reported cases of aseptic meningitis, bacterial meningitis, arachnoiditis, and conus medullaris syndrome [58,59]. Direct traumatic complications vary by level of injection.…”

Section: Complicationsmentioning

confidence: 99%

Epidural Steroid Injections

Wilkinson

Cohen

2011

Curr Pain Headache Rep

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Epidural steroid injection (ESI) is the most commonly performed intervention in pain clinics across the United States. This article provides an evidence-based review of ESI, including data on efficacy, patient selection, comparison of types, and complications. The data strongly suggest that ESI can provide short-term relief for radicular symptoms but are less compelling for long-term effects or relief of back pain. Although it has been asserted that transforaminal ESIs are more efficacious than interlaminar injections, the evidence supporting this is limited.

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Infectious Risks of Chronic Pain Treatments: Injection Therapy, Surgical Implants, and Intradiscal Techniques

Cited by 36 publications

References 29 publications

Epidural Steroids

Epidural Steroids

Spinal Cord Stimulation: A Review

Epidural Steroid Injections

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