Abstract:
Introduction. A variety of methods exist for the treatment of low back pain but none seems to be clearly superior. The purpose of the present study was to critically examine the efficacy of epidural injections of bupivacaine alone and mixed with steroids for the treatment of persistent low back pain with radiculopathy. Methodology. A prospective, randomized, controlled, comparative study was conducted at orthopaedic department, Mayo Hospital, Lahore. 60 patients with persistent low back pain with radiation to legs were randomized in two groups (30 each). There was no difference between the experimental and control group with regards to any of the measured variables including age, gender, number of level of disease, and diagnosis. Single epidural injection of bupivcaine with saline or bupivacaine, saline and triamcinolone were given. Pain assessment before and after the injection was done according to Pakistan coin pain scale. All patients had pain scores higher than 20 (on a scale of 1 to 100, with scores of 20 or less indicating minimal disability, and higher scores greater disability). Quality and duration of pain relief, straight leg raising sign, ankle jerk, blood pressure, pulse rate and any side effects were noted. Follow up was done at 1 week, 6 weeks and 12 weeks interval. Results. At two weeks interval, the pain score had improved by a mean of 8.0 in the triamcinolone group and -5.5 in the control group (95 percent confidence interval for the difference, -7.1 to 2.2). Differences in improvements between the groups were not significant, except for improvements in the straight leg raising sign (P=0.006) and sensory deficits (P = 0.03), which were greater in the triamcinolone group. After six weeks follow-up, the only significant difference was the improvement in leg pain, which was greater in the triamcinolone group (P===0.03). After three months follow up, there were no significant differences between the groups. The mean duration of pain relief in group A, was 50+6 days and in group B, was 56 +10 days. The difference was not significant (P>0.05). The pain relief of 3-month interval in group A, was 25 (83%) patients and in group B, 23(76%) patients have pain relief on less than 50% (P>0.05). In group A; 11(36%) patients complaint of headache, 3 (10%) patients complaint of shivering and 1 (3%) patient complaint of postural hypotension, rest of patients had no complication. In group B, 6(20%) patients had headache, 4(13%) patients complaint of postural hypotension, 1(3%) patient had complete motor paralysis and 3 (10%) patients complaint of shivering, 16 had no complication. Conclusion. Although epidural injections may offer short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposis, this treatment offers no significant functional benefit, nor does it reduce the need for surgery. The epidural steroid injection can be used for symptomatic treatment of low back pain.
Page(s):
144-148
DOI:
DOI not available
Published:
Journal: Pakistan Postgraduate Medical Journal, Volume: 15, Issue: 4, Year: 2004