PAIN UPDATE
from The Richeimer Pain Institute
April 2000
ARE EPIDURAL STEROIDS USEFUL? Injections
of steroids into the lumbar epidural space are frequently used for low
back and related radicular leg pains.
The question is do they work? The
answer: It depends on whom
you ask. The controlled studies
are split. Two major problems
complicate the story. The first
is that many different diagnoses may cause the pain, and epidural injections
may work for some of these diagnoses better than others.
The second problem is that the success of the injection may depend
on the technique that is used. The
traditional epidural injection technique involves the doctor feeling
the patient’s spine in order to guide the placement of a needle between
the spinal vertebrae. A newer
technique involves using x-ray fluoroscopy to guide the needle directly
to the neural foramen, the point where the affected spinal nerve root
exits the spine. This is likely to increase the success of the
procedure, but a controlled study using such injection techniques has
not yet been done. However,
a study in the Archives of Physical Medicine & Rehabilitation did
give added support to this idea. 75%
of the 69 patients treated with these more precisely placed injections
demonstrated good long-term benefit. At
The Richeimer Pain Institute, we also have had good results with this
refined epidural technique. For
patients with nerve root pain involving one or two roots, I believe
that fluoroscopically guided foraminal injections will prove to be superior
to the approaches that do not use x-ray guidance.
Epidurals in general, but especially foraminal injections, do
not appear to be as effective if the pain is caused by widespread degenerative
or arthritic problems in the spine.
Do
epidural steroid injections work?
Yes, if the problem is back and leg pain triggered lumbar disc
herniations, and if fluoroscopy is used to guide the injection directly
to the affected nerve roots. Do
epidural injections work for other causes of back pain? Good data is not available. In my experience, the injections can often
help, but with other diagnoses the rate of success is not as great. Until
next time… Steven
Richeimer, M.D. Thank you for subscribing to Pain Updates. Visit www.helpforpain.com to view archived Updates
. Your colleagues may add themselves to the list, or you may remove yourself from the mailing list by sending me a note at stevenr@paininstitute.md, or by contacting me through www.helpforpain.com. Copyright
© 2000, Steven Richeimer, MD. All rights reserved. |
The information on this internet site is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Helpforpain.com and The Richeimer Pain Institute may provide links to other organizations as a service to the users of this website. The Richeimer Pain Institute and helpforpain.com are not responsible for the information provided in any other website. |
Steven Richeimer,
MD
Copyright © 2000 [The Richeimer Pain Institute]. All rights reserved.
Site funded by The Richeimer Pain Institute, LLC