Pain reduction after lumbar epidural injections using particulate versus non-particulate steroids: intensity of the baseline pain matters

Tagowski, Marek; Lewandowski, Zbigniew; Hodler, J; Spiegel, Thomas; Goerres, Gerhard W.

doi:10.1007/s00330-019-06108-9

Cited by 15 publications

(21 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TFESI, transforaminal epidural steroid injection our department via prepaid post. Based on the therapeutic efficacy of the steroid injection, two groups were formed: (1) "good responder" with at least 50% reduction in NRS score 4 weeks after TFESI and (2) "poor responder" with below 50% reduction in NRS score 4 weeks after TFESI [17,20]. In a subgroup analysis, each patient with a baseline NRS score (before CT-guided TFESI) of < 4-representing only mildly symptomatic patients-were excluded, as the likelihood to benefit from a steroid injection is inherently lower in these patients, potentially confounding the results.…”

Section: Outcome Questionnairesmentioning

confidence: 99%

See 1 more Smart Citation

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

2021

View full text Add to dashboard Cite

Objective To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome. Materials and methods In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant. Results Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31). Conclusion Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

show abstract

Section: Outcome Questionnairesmentioning

confidence: 99%

“…Hence, the drugs are injected close to the pain source, i.e., the mechanically irritated, inflamed nerve root. Lumbar epidural steroid injections can be performed reliably, quickly, and safely with image guidance (fluoroscopy-guided or CT-guided) [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

2021

View full text Add to dashboard Cite

show abstract

“…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. Consistent with this, we found that the mechanical allodynia and pathological damage induced by LDH were improved by intrathecal delivery of dexamethasone.…”

Section: Discussionmentioning

confidence: 99%

“…The use of dexamethasone for radicular pain in LDH, which started in 1975, demonstrated that it confers prompt relief of pain caused by LDH and may obviate the need for surgery in most patients 11 . Moreover, Tagowski et al 12 found that dexamethasone alleviates pain mediated by LDH more effectively than it acts on pain induced by fixed stenotic spinal lesions. Kennedy et al 13 demonstrated that transforaminal epidural injection of dexamethasone is an effective therapy for acute radicular pain due to disc herniation and it has effects similar to those of triamcinolone, but more doses of dexamethasone have been injected to achieve the same effect as triamcinolone.…”

Section: Introductionmentioning

confidence: 99%

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

Ding

Sheng

et al. 2020

Pain Practice

View full text Add to dashboard Cite

PurposeLumbar disc herniation (LDH) is a frequently occurring disease with unknown etiology, which makes treatment a challenge. The aim of this study was to analyze the effects of dexamethasone on LDH and elucidate the underlying mechanisms.General MethodsAn LDH rat model was established by nucleus pulposus implantation. The activity of the lipocalin type prostaglandin D synthase (L‐PGDS)/phosphoinositide 3‐kinase (PI3K)/protein kinase B (Akt) axis was evaluated by Western blotting. Paw withdrawal threshold and paw withdrawal latency were assessed by the Von Frey hairs method and the thermal dolorimeter of Hargreaves, respectively. The 21‐point Basso‐Beattie‐Bresnahan scale was used to assess the locomotor function of rats. Pathological changes in the affected region were analyzed by hematoxylin‐eosin staining. Immunofluorescence was used to measure the expression of microtubule‐associated protein (MAP‐2).FindingsLumbar disc herniation markedly increased thermo‐mechanical allodynia and induced dorsal root ganglion (DRG) degeneration by inactivating the L‐PGS/PI3K/Akt pathway. Dexamethasone restored the L‐PGDS/PI3K/Akt pathway and relieved LDH‐induced thermo‐mechanical allodynia. Furthermore, overexpression and knockdown of L‐PGDS respectively attenuated and worsened LDH‐triggered thermo‐mechanical allodynia and tissue degeneration by modulating the PI3K/Akt pathway. Pretreatment with dexamethasone partially abrogated the effect of L‐PGDS knockdown through PI3K/Akt activation.ConclusionsDexamethasone relieves LDH‐mediated radicular pain by exerting anti‐inflammatory effects and reducing the suppression of L‐PGDS induced by LDH. Meanwhile, the activity of the PI3K/Akt pathway was decreased, possibly due to the attenuated inflammation induced by dexamethasone. Our results revealed the underlying mechanism of dexamethasone, which might be helpful in reducing the side effects of dexamethasone and provide more focused therapy in LDH.

show abstract

“…At 1 week, significantly more patients in the dexamethasone group reported “worsening” symptoms. 70 In the Tagowski et al’s 71 study, 34.9% of dexamethasone-treated patients experienced ≥50% pain reduction in Numerical Rating Scale (NRS) score compared with 49.2% of triamcinolone-treated patients 4 weeks after treatment. The superiority of the particulate steroid was dependent on the baseline pain level, as the proportion of patients with ≥50% pain reduction was similar for dexamethasone and triamcinolone in patients with low levels of baseline pain.…”

Section: Narrative Review Of Studies Comparing Particulate and Nonparticulate Epidural Steroids For Lumbosacral Radiculopathymentioning

confidence: 99%

Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

Cohen

Greuber²,

Vought³

et al. 2021

The Clinical Journal of Pain

View full text Add to dashboard Cite

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.

show abstract

Pain reduction after lumbar epidural injections using particulate versus non-particulate steroids: intensity of the baseline pain matters

Cited by 15 publications

References 42 publications

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

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

Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain

Contact Info

Product

Resources

About