Role of Neuraxial Steroids in Interventional Pain Management

Manchikanti, Laxmaiah

doi:10.36076/ppj.2002/5/182

Cited by 154 publications

(26 citation statements)

References 179 publications

(213 reference statements)

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“…In contrast, PRF controlled the shoulder pain indirectly by acting on the SSN. Despite the superior effect of the ICI, its potential adverse effects should be considered [9,10]. Therefore, PRF treatment of the SSN may be a helpful therapeutic modality in the management of HSP, especially in patients contraindicated for or who experience significant side effects with corticosteroid injections.…”

Section: Discussionmentioning

confidence: 99%

“…For the treatment of persistent HSP, unresponsive to conventional modes of therapy, intra-articular corticosteroid injection (ICI) into the shoulder joint is widely used, but its palliative effect has only a relatively short duration [8]. Furthermore, corticosteroids may have adverse effects, including allergic reactions, flushing, hyperglycemia, menstrual disturbances and adrenal suppression [9,10]. Suprascapular nerve block (SSNB) is another option for relieving HSP [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Kim

Lee

2021

J. Integr. Neurosci.

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Many patients complain of hemiplegic shoulder pain following stroke. Here, the effectiveness of pulsed radiofrequency stimulation of the suprascapular nerve is compared with intra-articular corticosteroid injection for chronic hemiplegic shoulder pain following stroke. This single-center, prospective, randomized controlled study included 20 patients with hemiplegic shoulder pain after stroke, randomly assigned to the pulsed radiofrequency and intra-articular corticosteroid injection treatment groups (n = 10 in each). Hemiplegic shoulder pain severity was measured by numeric rating scale and passive shoulder range motion was assessed at baseline and one and two months after each procedure. Compared to the baseline numeric rating scale scores, post-treatment scores decreased significantly in both groups (p < 0.001). However, score reduction through time was significantly greater for intra-articular corticosteroid injection for pulsed radiofrequency (p < 0.001). Similarly, a significant post-treatment increase was observed in almost all range of motion measurements in both groups (pulsed radiofrequency group: flexion, p = 0.015; abduction, p = 0.014; external rotation, p = 0.038; internal rotation, p = 0.063; intra-articular corticosteroid injection group: all range of motion, p < 0.001). Moreover, the measurements for all ranges of motion in the intra-articular corticosteroid injection group were significantly higher than those in the pulsed radiofrequency group (p < 0.001). Thus, intra-articular corticosteroid injection appears more effective than pulsed radiofrequency for control of hemiplegic shoulder pain, whereas, pulsed radiofrequency of the suprascapular nerve has minimal effect. However, in patients at risk for developing complications following corticosteroid injections, pulsed radiofrequency of the suprascapular nerve may be an option in management of hemiplegic shoulder pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Kim

Lee

2021

J. Integr. Neurosci.

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“…The underlying mechanism of action of epidurally administered steroid and local anesthetic injections is still not well understood. It is believed that the achieved neural blockade alters or interrupts nociceptive input, reflex mechanism of the afferent fibers, self-sustaining activity of the neurons, and the pattern of central neuronal activities (5,21,68,96,97). Further, corticosteroids have been shown to reduce inflammation by inhibiting either the synthesis or release of a number of pro-inflammatory mediators and by causing a reversible local anesthetic effect (97)(98)(99)(100)(101)(102)(103)(104)(105).…”

Section: Rationalementioning

confidence: 99%

Protocol for Evaluation of the Comparative Effectiveness of Percutaneous Adhesiolysis and Caudal Epidural Steroid Injections in Low Back and/or Lower Extremity Pain without Post Surgery Syndrome or Spinal Stenosis

Manchikanti

Pampati²,

Cash³

2010

Pain Phys

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Background: Treatment of chronic low back pain with or without lower extremity pain continues to be a challenge. Epidural steroids are commonly utilized in patients after the failure of conservative treatment. The results of epidural steroid injections have been variable based on the pathophysiology, the route of administration, injected drugs, and utilization of fluoroscopy. In patients resistant to fluoroscopically directed epidural injections, percutaneous epidural adhesiolysis and percutaneous targeted delivery of injections with or without adhesiolysis has been recommended. Percutaneous adhesiolysis has been studied in chronic pain syndromes related to post laminectomy syndrome and spinal stenosis with encouraging results. There is a paucity of literature regarding the effectiveness of the targeted delivery of medications with or without epidural adhesiolysis in patients recalcitrant to epidural steroid injections without a history of surgery and spinal stenosis. Study Design: A randomized, equivalence trial of percutaneous lumbar adhesiolysis and caudal epidural steroid injections in patients with low back and/or lower extremity pain without post surgery syndrome or spinal stenosis. Setting: An interventional pain management practice setting in the United States. Objective: The study is designed to evaluate the effectiveness of percutaneous epidural adhesiolysis in managing chronic low back and/or lower extremity pain in patients without post lumbar surgery syndrome or spinal stenosis and compare it with fluoroscopically directed caudal epidural steroid injections Methods: The study design includes 120 patients randomly assigned into 2 groups. Group I (60 patients), the control group, will receive caudal epidural injections with catheterization up to S3 with local anesthetic, steroids, and 0.9% sodium chloride solution; Group II (60 patients), the intervention group, will receive percutaneous adhesiolysis with target delivery of lidocaine, 10% hypertonic sodium chloride solution, and non-participate betamethasone. Randomization will be performed by computer-generated random allocation sequence by simple randomization. Outcome Measures: Multiple outcome measures will be utilized including numeric rating scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, 12, 18 and 24 months post treatment. Significant pain relief is considered as 50% or more, whereas significant improvement in the disability score is defined as a reduction of 40% or more. Results: The results will be analyzed to show significant relief as well as improvement in functional status. Limitations: This study is limited by potentially inadequate double blinding and the lack of a placebo group.Conclusion: This protocol describes a comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing chronic low back and lower extremity pain in patients without post surgery syndrome or spinal stenosis utilizing a randomized, equivalence trial design. Clinical Trial Registration: NCT01053273 Key words: Chronic low back pain, disc herniation, post lumbar surgery syndrome, spinal stenosis, epidural steroid injections, percutaneous adhesiolysis, randomized trial, comparative effectiveness

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“…It is believed that the achieved neural blockade alters or interrupts nociceptive input, reflex mechanism of the afferent fibers, self-sustaining activity of the neurons, and the pattern of central neuronal activities. Further, corticosteroids have been shown to reduce inflammation by inhibiting either the synthesis or release of a number of pro-inflammatory mediators and by causing a reversible local anesthetic effect [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the underlying mechanism of epidural administered local anesthetic and steroid injections in the treatment of chronic low back pain still remains unknown [13,14]. According to the current evidence, there is a trend suggesting that local anesthetics might have comparable effectiveness as steroids in the treatment of low back pain without LDH and also pain of facet joint origin [15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of epidural injection of steroid in treatment of lumber disc prolapse: article review

AL-Dahhan¹

2021

MMJ

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"Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. To describe the indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural corticosteroid injections. Interventions: Three reviewers with formal training and certification in evidence-based medicine searched the literature on non–image guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. A systematic literature search was performed, in the Medline Case reports and retrospective and prospective studies were extensively reviewed to provide detailed descriptions of the clinical features of lumbar and caudal epidural corticosteroid injections. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE , and manual searches of bibliographies of known primary and review articles. Epidural corticosteroid injections are commonly requested treatments for patients with various low-back or lower-extremity pain syndromes (or both). Most of the reports on the use of this type of treatment are retrospective and noncontrolled. These studies indicate benefit; however, the prospective controlled studies provide varied results about the efficacy of lumbar and caudal epidural corticosteroid injections. In conclusions: In patients with lumbar radicular pain secondary to disc herniation or neurogenic claudication due to spinal stenosis, interlaminar epidural steroid injections appear to have clinical effectiveness limited to short-term pain relief. Therefore, in a contemporary medical practice, these procedures should be restricted to the rare settings where fluoroscopy is not available."

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Role of Neuraxial Steroids in Interventional Pain Management

Cited by 154 publications

References 179 publications

Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Protocol for Evaluation of the Comparative Effectiveness of Percutaneous Adhesiolysis and Caudal Epidural Steroid Injections in Low Back and/or Lower Extremity Pain without Post Surgery Syndrome or Spinal Stenosis

Efficacy of epidural injection of steroid in treatment of lumber disc prolapse: article review

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