Year: 2008
Type: article
Abstract: I n this issue of Pain Physician, Manchikanti and colleagues (1-4) report preliminary results of 4 studies designed to assess the benefit of adding corticosteroid to caudal epidural injection of local anesthetic for chronic low back and leg pain.Patients enrolled had one of 4 pain etiologies: discogenic, radicular, postoperative back, or spinal stenosis.In each of the 4 trials, subjects were randomly assigned to a group receiving lidocaine only or another receiving lidocaine plus corticosteroid.The volumes used (10 mL) were likely sufficient to fill the caudal space, but small by historical standards (5-8).Manchikanti's group found that on average pain and functional status of patients in all 4 studies improved during 12 months of follow-up after enrollment.Perhaps more importantly, there was no advantage seen with addition of epidural corticosteroid.The results of these studies cast doubt on the central role that epidural corticosteroid injections have played for more than half a century since the compounds were originally introduced by Hench, Kendall, and others for the treatment of rheumatoid arthritis (9).Prior to Hench et al's work, Evans (7) hypothesized that local anesthetic injected transsacrally might reduce symptoms caused by pressure on nerves.These early injections were high volume caudals, usually of the local anesthetic procaine alone; only later were hydrocortisone acetate or other steroids added (8).A recent study compared targeted versus non-targeted caudal injections for the treatment of radiculitis.Targeted injections were performed via a caudally introduced endoscope and produced no major improvement in pain intensity versus non-targeted injections during a 6-month follow-up period.Pain, anxiety, and depression all improved in the non-targeted caudal
Source: Pain Physician
Author: Marc A. Huntoon
Institution: Mayo Clinic
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3136943153