Methylprednisolone Acetate Versus Triamcinolone Acetonide for Pain Relief in Spinal Nerve Root Block for Low Back Pain

Abstract Background: To investigate the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of patients who were diagnosed with lumbar disc herniation (LDH) with positive nerve root sedimentation sign (NRSS).Methods: A total of 86 patients who underwent LDH were recruited and divided into NRSS-positive group (n=49) and NRSS-negative group(n=37). The visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) were used to evaluate the low back pain and functional recovery and were compared between the two groups.Results: There were no significant differences in the demographic parameters between the two groups. The average area of the dural sac compression in the NRSS-positive group was significantly higher than that in the NRSS-negative group. Patients with a positive NRSS showed a better low back pain relief than those with a negative NRSS at 1 week and 1 month after surgery. The JOA and ODI in the NRSS-positive group were better than those in the NRSS-negative group at 3 months and 6 months postoperatively. The apparent efficiency of JOA and the excellent and good rate of ODI in the negative group was lower than that in the positive group at 6 months after surgery. Conclusions: Patients undergoing LDH with a positive NRSS showed better pain relief and functional recovery than those with a negative NRSS. The present study suggested that NRSS might be a valuable sign and associated with better clinical outcomes in patients undergoing LDH with the treatment of PTED.

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Management of Patients with L2 Spinal Nerve Root Block Who Are Suffering from Low Back and Referred Pain

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2014.21.1.8 ◽

2014 ◽

Vol 21 (1) ◽

pp. 8 ◽

Cited By ~ 1

Author(s):

Dong Ki Ahn ◽

Song Lee ◽

Tae Woo Kim ◽

Sung Won Hong ◽

Woo Sik Jung

Keyword(s):

Nerve Root ◽

Spinal Nerve ◽

Referred Pain ◽

Low Back ◽

Spinal Nerve Root ◽

Nerve Root Block

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Study of efficacy of epidural methylprednisolone acetate and triamcinolone acetate for treatment of low back pain and radiculopathy

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20194232 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1632

Author(s):

Heena D. Pahuja ◽

Kiran R. Vyawahare ◽

Pradeep G. Dhumane

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Activity Score ◽

Acetate Group ◽

Methylprednisolone Acetate ◽

Low Back ◽

Group 2 ◽

Epidural Steroid ◽

Group 1

Background: Epidural steroids have been proven to be one of the most effective non-operative managements of back pain. The present study entailed evaluation of the efficacy of epidural methylprednisolone acetate and triamcinolone acetate for treatment of low back pain and radiculopathy.Methods: The two groups of 25 participants, formed on the basis of the injectable epidural steroid used {80mg of methylprednisolone acetate (group 1) or 40mg of triamcinolone acetate (group 2)}, were enrolled after following due selection criteria. After detailed history taking, examination and requisite investigations, 15 ml volume of the drug was injected epidurally with the patient lying in lateral position. The patients were followed-up at 3 weeks, 6 weeks and 3 months and pain assessment and percentage of pain relief was noted in comparison with the level of pain before epidural injection. Sleep quality, activity score, days in bed, analgesic requirement, complications and requirement of surgical intervention were all assessed at each follow-up.Results: The mean pain score was significantly less in group 1 after 6 weeks and 3 months period, with 60% in group 1 having “good” pain relief, while 69.56% amongst group 2 participants reported “fair” pain relief. Eighty four percent group 1 participants required 2 injections, while 64% participants in group 2 required 3 injections. There was overall improvement in the activity score, quality of sleep and decrease in bed rest and analgesic requirement.Conclusions: Epidural steroid therapy is highly efficacious and methylprednisolone acetate is more effective than triamcinolone acetate; with negligible complications.

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Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study)

BMJ Open ◽

10.1136/bmjopen-2021-052703 ◽

2022 ◽

Vol 12 (1) ◽

pp. e052703

Author(s):

Ingrid Schuttert ◽

Hans Timmerman ◽

Gerbrand J Groen ◽

Kristian Kjær Petersen ◽

Lars Arendt-Nielsen ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Healthy Volunteers ◽

Chronic Low Back Pain ◽

Nerve Root ◽

Pain Clinic ◽

Low Back ◽

Central Sensitisation ◽

Nerve Root Block ◽

Selective Nerve Root Block

IntroductionPatients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term ‘human assumed central sensitisation’ (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers.Methods and analysisA prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance.Ethics and disseminationThe Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences.Trial registration numberNTR NL6765.

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Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/333 ◽

2008 ◽

Vol 3;11 (5;3) ◽

pp. 333-338

Author(s):

Asokumar Buvanendran

Keyword(s):

Spinal Cord ◽

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Pain Relief ◽

Failed Back Surgery Syndrome ◽

Low Back ◽

Failed Back Surgery ◽

Back Surgery ◽

Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

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P.087 RETRACTION - Low back pain relief with a new 32-contact surgical lead and neural targeting algorithm

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.214 ◽

2017 ◽

Vol 44 (6) ◽

pp. 763-763

Author(s):

J. Pilitisis ◽

G. Barolat ◽

J. Rosenow ◽

J. Brennan ◽

A. Bailey ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Low Back

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Lumbar Facet Joint Nerve Blocks in Managing Chronic Facet Joint Pain: One-Year Follow-up of a Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/121 ◽

2008 ◽

Vol 2;11 (3;2) ◽

pp. 121-132

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Local Anesthetic ◽

Chronic Low Back Pain ◽

Facet Joint ◽

Low Back ◽

Lumbar Facet Joint ◽

Nerve Blocks ◽

Lumbar Facet

Background: Lumbar facet joints have been implicated as the source of chronic pain in 15% to 45% of patients with chronic low back pain. Various therapeutic techniques including intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Objective: The study was conducted to determine the clinical effectiveness of therapeutic local anesthetic lumbar facet joint nerve blocks with or without steroid in managing chronic function-limiting low back pain of facet joint origin. Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management setting in the United States. Methods: This study included 60 patients in Group I with local anesthetic and 60 patients in Group II with local anesthetic and steroid. The inclusion criteria was based on the positive response to the diagnostic controlled comparative local anesthetic lumbar facet joint blocks. Outcome measures: Numeric pain scores, Oswestry Disability Index, opioid intake, and work status. All outcome assessments were performed at baseline, 3 months, 6 months, and 12 months. Results: Significant improvement with significant pain relief (> 50%) and functional improvement (> 40%) were observed in 82% and 85% in Group I, with significant pain relief in over 82% of the patients and improvement in functional status in 78% of the patients. Based on the results of the present study, it appears that patients may experience significant pain relief 44 to 45 weeks of 1 year, requiring approximately 3 to 4 treatments with an average relief of 15 weeks per episode of treatment. Conclusion: Therapeutic lumbar facet joint nerve blocks, with or without steroid, may provide a management option for chronic function-limiting low back pain of facet joint origin. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic lumbar facet joint nerve blocks

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