Long-Term Complications of Epidural Steroid Injections

Jung, Jae Ho; Ignatius, Mark I.; Davis, Jason M.; Jim, Lysander

doi:10.1007/s40141-013-0038-6

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…Despite the wide use of local anaesthetic solutions and corticosteroids in epidural anaesthesia in man and in animals, both have been documented to have neurotoxic effects (Jung et al . ; Verlinde et al . ; Schlatter et al .…”

Section: Discussionmentioning

confidence: 99%

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Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses

Nagy

Dyson

2019

Equine Veterinary Education

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Sacroiliac (SI) joint region pain is relatively common in sports horses and diagnosis is ideally confirmed by diagnostic analgesia (SI joint region blocks). Anecdotal reports describe complications following SI joint region blocks, but there is no detailed published information. Our aim was to document a series of horses that became recumbent following SI joint region blocks. Clinicians were asked to participate via the email list of the American College of Veterinary Sports Medicine and Rehabilitation and by contacting clinicians known to the authors to investigate poor performance and lameness in sports horses. Horses (n = 15) were included if they became recumbent following SI joint region blocks, with or without using other substances in addition to local anaesthetic solution. Data on the clinicians' experience, injection technique, clinical findings before and while the horse was recumbent and the outcome were collected in an online questionnaire. The clinicians' experience and injection techniques varied. In three horses corticosteroids, with or without pitcher plant extract, were also injected with the local anaesthetic solution. In 14 horses, the injection(s) were performed at a clinic or hospital; 13 horses were injected in stocks. Seven horses were sedated for the procedure. Fourteen horses became recumbent within 10 min and one within 20 min. While recumbent, seven horses were sedated and six anaesthetised. Fourteen horses stood up at a mean time of 3.8 h after becoming recumbent; additional information was available for 13 horses, all of which made a complete recovery. Three horses suffered temporary complications (pneumonia related to intubation, abrasions from a sling and radial nerve dysfunction associated with slinging). One horse was euthanised after 3 days because of failure to regain hindlimb function. In conclusion, recumbency following diagnostic analgesia of the SI joint regions can occur, but in the majority of horses, it has no long-term consequences.

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Section: Discussionmentioning

confidence: 99%

“…In the case of corticosteroids, neurotoxicity is more likely to be associated by preservatives used in depo preparations (Jung et al . ; Natalini ). Corticosteroids have also been associated with infarct‐related spinal cord and nerve root damage if injected intravascularly (Goodman et al .…”

Section: Discussionmentioning

confidence: 99%

Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses

Nagy

Dyson

2019

Equine Veterinary Education

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“…18 Neurotoxic effects have been documented for both local anaesthetic solutions and corticosteroids. 19,20 With regards to corticosteroids, neurotoxicity is more likely to be associated by preservatives used in depo preparations. 19 Corticosteroids have also been associated with infarct-related spinal cord and nerve root damage if injected intravascularly.…”

Section: Diffusion Of Local Anaesthetic Solution To Nerve Roots and A...mentioning

confidence: 99%

“…19,20 With regards to corticosteroids, neurotoxicity is more likely to be associated by preservatives used in depo preparations. 19 Corticosteroids have also been associated with infarct-related spinal cord and nerve root damage if injected intravascularly. 18 Pitcher plant extract has been used for decades in man for epidural, paravertebral, and perineural injections with no reported side effects.…”

Section: Diffusion Of Local Anaesthetic Solution To Nerve Roots and A...mentioning

confidence: 99%

Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences

Nagy

Dyson

2023

Equine Veterinary Journal

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BackgroundThere are no detailed data on complications of sacroiliac (SI) joint region injections or on the variability of the methods and circumstances of injections among clinicians.ObjectivesTo describe complications following diagnostic, therapeutic and combined SI joint region injections and the details of how these are routinely performed by a large number of clinicians.Study designCross‐sectional questionnaire survey.MethodsClinicians (members of American and European specialist colleges and veterinarians known to the authors), invited by email, who had performed ≥1 SI joint region injection, completed an online questionnaire. Data collected included the clinicians' experience in diagnostic, therapeutic and combined SI joint region injections, details of the injection technique, volume and substance used, and the type of complications seen following SI joint region anaesthesia, medications and combined injections, respectively. Descriptive data analysis was performed and the association between any complications seen and the clinicians' experience, technique, volume and substance used were assessed using binary logistic regression.ResultsOf the 212 respondents, 110 had performed diagnostic, 187 therapeutic and 49 combined injections. More clinicians experienced complications after diagnostic (53/110) than after therapeutic (33/187) or combined (6/49) injections (p < 0.01). The most common complications were hindlimb weakness/ataxia after all types of injections (diagnostic: 44/110, 40%, 95% confidence interval [CI]: 30.8–49.8; therapeutic: 15/187, 8.0%, CI: 4.6–12.9; combined: 2/49, 4.1%, CI: 0.5–14.0). Death or horses requiring euthanasia were reported (after therapeutic injections: 5/187; diagnostic injections: 1/110).Main limitationsNo prevalence of complications was established; no detailed descriptions of complications were available. Results may be influenced by selection and recall biases.ConclusionsComplications were experienced by more clinicians following diagnostic injections than after therapeutic or combined SI joint region injections, but the types and distribution of complications were similar. Results should be interpreted considering the previous reports of low prevalence of complications.

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“…An estimated 20% of the world's population lives in chronic pain (Goldberg and McGee, 2011) and 17.6% of those in chronic pain in the U.S. rate their pain as severe (Nahin, 2015;Becker et al, 2017). Traditional treatments for pain have relied on medications, in particular opioids, or invasive interventions, such as nerve blocks or epidural injections, each with their own risk profile (Benyamin et al, 2008;Bellini and Barbieri, 2013;Jung et al, 2014;Teater, 2014;Webster, 2017;Liberman et al, 2019;Chuan et al, 2020;Smith et al, 2020). In light of the current opioid overdose death crisis, there is an urgent need for implementation of noninvasive complementary and alternative modalities for the treatment of pain, both acute and chronic.…”

Section: Introductionmentioning

confidence: 99%

Effect of Immersive Virtual Reality on Pain and Anxiety at a Veterans Affairs Health Care Facility

Rawlins

Veigulis

Hebert

et al. 2021

Front. Virtual Real.

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Objectives: The primary objective of this evaluation is to determine the impact of virtual reality (VR) distraction on acute and chronic pain in Veterans within the Veterans Affairs Health Care System (VA). A secondary objective is to determine the impact of VR on the experience of stress and anxiety in Veterans utilizing VR for the indication of pain. A third objective is to develop an understanding of the Veteran experience of using VR in a healthcare setting.Methods: This prospective, pretest-posttest mixed methods assessment was performed at a VA medical center from August 30, 2019 to November 23, 2020. VR experiences lasted between 10 and 30 min utilizing an immersive head-mounted display with multiple, autonomously chosen virtual environments. Qualitative data was collected concurrently to provide context to quantitative measures which included pain scores and stress/anxiety levels. Data from 79 participants was included in this analysis. Data included pre- and post-VR session Defense and Veterans Pain Rating Scale and stress/anxiety levels.Results: Results for the cohort demonstrated a statistically significant decrease in pain intensity (p <0 .001) with an average 12% decrease in pain levels and an 92% reduction in anxiety for those in concurrent pain.Conclusion: VR as a non-pharmacological adjunct or alternative modality, appears to be a viable option for improving pain management and reducing anxiety in Veteran populations across various age ranges, and levels of acuity and chronicity. VR was found to be an effective distraction from pain, a pleasurable experience for the majority, and opened the door to other non-pharmacological modalities in a Veteran population.

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Long-Term Complications of Epidural Steroid Injections

Cited by 7 publications

References 25 publications

Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses

Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses

Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences

Effect of Immersive Virtual Reality on Pain and Anxiety at a Veterans Affairs Health Care Facility

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