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AIMS Neuroscience

2022, Volume 9, Issue 1: 24-30. doi: 10.3934/Neuroscience.2022003
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Research article

Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study

  • 1.
    Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital of Daegu, Daegu, South Korea
  • 2.
    Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, South Korea
  • Received: 19 October 2021 Revised: 20 December 2021 Accepted: 05 January 2022 Published: 18 January 2022

  • Background

    Low back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection.

     Methods

    This was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later.

     Results

    A total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18.

     Conclusion

    For the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

    Citation: Chan Hong Park, Sang Ho Lee. Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study[J]. AIMS Neuroscience, 2022, 9(1): 24-30. doi: 10.3934/Neuroscience.2022003

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  • Background

    Low back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection.

     Methods

    This was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later.

     Results

    A total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18.

     Conclusion

    For the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.


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    Conflict of interest


    All authors declare no conflicts of interest.

    [1] Olmarker K, Byröd G, Cornefjord M, et al. (1994) Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine 19: 1803-1808. https://doi.org/10.1097/00007632-199408150-00003. doi: 10.1097/00007632-199408150-00003
    [2] Koc Z, Ozcakir S, Sivrioglu K, et al. (2009) Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine 34: 985-989. https://doi.org/10.1097/BRS.0b013e31819c0a6b. doi: 10.1097/BRS.0b013e31819c0a6b
    [3] Delport EG, Cucuzzella AR, Marley JK, et al. (2004) Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil 85: 479-484. https://doi.org/10.1016/S0003-9993(03)00472-6. doi: 10.1016/S0003-9993(03)00472-6
    [4] Manchikanti L, Cash KA, McManus CD, et al. (2010) A preliminary report of a randomized double-blind, active controlled trial of fluoroscopic thoracic interlaminar epidural injections in managing chronic thoracic pain. Pain Physician 13: E357-E369. https://doi.org/10.36076/ppj.2010/13/E357. doi: 10.36076/ppj.2010/13/E357
    [5] Sari S, Aydin ON, Güleser G, et al. (2015) Effect of transforaminal anterior epidural steroid injection on neuropathic pain, quality of sleep and life. Agri 27: 83-88. https://doi.org/10.5505/agri.2015.91489.
    [6] Rados I, Zdravcevic KS, Hrgovic Z (2013) painDETECT questionnaire and lumbar epidural steroid injection for chronic radiculopathy. Eur Neurol 69: 27-32. https://doi.org/10.1159/000338265. doi: 10.1159/000338265
    [7] Nicholson B (2006) Differential diagnosis: nociceptive and neuropathic pain. Am J Manag Care 12: S256-S262.
    [8] Dworkin RH, O'Connor AB, Kent J, et al. (2013) Interventional management of neuropathic pain: NeuPSIG recommendations. Pain 154: 2249-2261. https://doi.org/10.1016/j.pain.2013.06.004. doi: 10.1016/j.pain.2013.06.004
    [9] Carette S, Leclaire R, Marcoux S, et al. (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336: 1634-1640. https://doi.org/10.1056/NEJM199706053362303. doi: 10.1056/NEJM199706053362303
    [10] Cappio M (1957) Sacral epidural administration of hydrocortisone in therapy of lumbar sciatica; study of 80 cases. Reumatismo 9: 60-70.
    [11] Abdi S, Datta S, Lucas LF (2005) Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician 8: 127-143. https://doi.org/10.36076/ppj.2006/9/127.
    [12] McCormick Z, Kennedy DJ, Garvan C, et al. (2015) Comparison of pain score reduction using triamcinolone vs. betamethasone in transforaminal epidural steroid injections for lumbosacral radicular pain. Am J Phys Med Rehabil 94: 1058-1064. https://doi.org/10.1097/PHM.0000000000000296. doi: 10.1097/PHM.0000000000000296
    [13] Park CH, Lee SH, Kim BI (2010) Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med 11: 1654-1658. https://doi.org/10.1111/j.1526-4637.2010.00941.x. doi: 10.1111/j.1526-4637.2010.00941.x
    [14] Shakir A, Ma V, Mehta B (2013) Comparison of pain score reduction using triamcinolone vs. dexamethasone in cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil 92: 768-775. https://doi.org/10.1097/PHM.0b013e318282c9f2. doi: 10.1097/PHM.0b013e318282c9f2
    [15] Langhoff E, Madsen S (1983) Rapid metabolism of cyclosporin and prednisone in kidney transplant patient receiving tuberculostatic treatment. Lancet 2: 1031https://doi.org/10.1016/S0140-6736(83)91019-X. doi: 10.1016/S0140-6736(83)91019-X
    [16] Derby R, Lee SH, Date ES, et al. (2008) Size and aggregation of corticosteroids used for epidural injections. Pain Med 9: 227-234. https://doi.org/10.1111/j.1526-4637.2007.00341.x. doi: 10.1111/j.1526-4637.2007.00341.x
    [17] Manchikanti L, Candido KD, Singh V, et al. (2014) Epidural steroid warning controversy still dogging FDA. Pain Physician 17: E451-E474. https://doi.org/10.36076/ppj.2014/17/E451. doi: 10.36076/ppj.2014/17/E451
    [18] Scanlon GC, Moeller-Bertram T, Romanowsky SM, et al. (2007) Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine 32: 1249-1256. https://doi.org/10.1097/BRS.0b013e318053ec50. doi: 10.1097/BRS.0b013e318053ec50
    [19] Tiso RL, Cutler T, Catania JA, et al. (2004) Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J 4: 468-474. https://doi.org/10.1016/j.spinee.2003.10.007. doi: 10.1016/j.spinee.2003.10.007
    [20] Muro K, O'Shaughnessy B, Ganju A (2007) Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection: case report and review of the literature. J Spinal Cord Med 30: 385-388. https://doi.org/10.1080/10790268.2007.11753957. doi: 10.1080/10790268.2007.11753957
    [21] Houten JK, Errico TJ (2002) Paraplegia after lumbosacral nerve root block: report of three cases. Spine J 2: 70-75. https://doi.org/10.1016/S1529-9430(01)00159-0. doi: 10.1016/S1529-9430(01)00159-0
    [22] Baker R, Dreyfuss P, Mercer S, et al. (2003) Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103: 211-215. https://doi.org/10.1016/S0304-3959(02)00343-3. doi: 10.1016/S0304-3959(02)00343-3
    [23] Rathmell JP, Aprill C, Bogduk N, et al. (2004) Cervical transforaminal injection of steroids. Anesthesiology 100: 1595-1600. https://doi.org/10.1097/00000542-200406000-00035. doi: 10.1097/00000542-200406000-00035
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