Abstract:
BACKGROUND:Epidural injection is performed for treatment of back and radicular pain in patients with lumbosacral disc herniation (LDH). Steroids are usually administered to effectively remove inflammatory mediators, and local anesthetics or saline also contribute to pain reduction by washing out chemical mediators or blocking the nociceptor activity. Controversy exists regarding whether steroids produce superior clinical effects compared with local anesthetics or saline. OBJECTIVES:This study investigated whether epidural injection of steroids produces better clinical effects than local anesthetics or saline in the treatment of LDH. STUDY DESIGN:A literature search was performed in MEDLINE, EMBASE, Cochrane review, and KoreaMed for studies published from January 1996 until July 2017. From among the studies fulfilling the search criteria, those that compared the clinical efficacy of steroids and control agents, such as local anesthetics or saline, in terms of pain control and functional improvement were included in this study. Exclusion criteria included a previous history of lumbosacral surgery, non-specific low back pain, severe spinal stenosis, and severe disc degeneration. SETTING:A systematic review and meta-analysis using a random effects model on randomized controlled studies (RCTs). METHODS:After reviewing titles, abstracts, and full texts of 6,711 studies that were chosen following removal of duplicates after the initial database search, 15 randomized controlled studies were included in our qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from 14 studies and analyzed using a random effects model to calculate the effect size and its corresponding statistical significance. Quality and level of evidence were established in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS:Steroids and local anesthetics were shown to be effective. Steroid showed significantly better pain control than control agents at 1 month, 3 months, and 6 months. The superiority of steroid in pain control was more prominent at one month, but diminished from 3 months to 1 year, showing no significant superiority in terms of mean difference, With respect to functional score, no significant difference was observed between steroids and control agents. The subgroup analysis showed that steroid revealed significant superiority in pain and functional score at 1 month to saline rather than local anesthetics. Generally, the quality of included studies was evaluated as high-grade, but the evidence level was determined to be moderate, due to inconsistencies. LIMITATION:Analyses of safety or adverse effects could not be performed due to a lack of available data from the included studies. CONCLUSIONS:Steroid is recommended over local anesthetics or saline for pain control in patients with LDH, with a weak strength of recommendation. The superiority of steroids was remarkable, especially at relatively short-term follow-ups, and maintained until the 1 year follow-up. The clinical benefits of steroids at 1 month were more prominent when compared with saline, than when compared with local anesthetics. KEY WORDS:Steroid, local anesthetics, saline, epidural injection, pain, function, meta-analysis, systemic review.
journal_name
Pain Physicianjournal_title
Pain physicianauthors
Lee JH,Kim DH,Kim DH,Shin KH,Park SJ,Lee GJ,Lee CH,Yang HSsubject
Has Abstractpub_date
2018-09-01 00:00:00pages
449-468issue
5eissn
1533-3159issn
2150-1149journal_volume
21pub_type
杂志文章,meta分析相关文献
Pain Physician文献大全abstract:BACKGROUND:Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that ca...
journal_title:Pain physician
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and t...
journal_title:Pain physician
pub_type: 杂志文章,多中心研究
doi:
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Pain arising from the lumbar facet joints is a common cause of axial back pain in adults. Radiofrequency neurotomy (RFN) of the medial branches of the spinal dorsal rami has been used as a treatment option. The most common side effect is transient, localized, burning, neuritic-type pain, termed post-neurotom...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Before long-term intrathecal analgesic therapy is initiated, patients often undergo a spinal analgesia trial. Ziconotide is a nonopioid intrathecal analgesic used to manage severe chronic pain, and a variety of methods have been used to trial ziconotide. OBJECTIVES:The purpose of this review is to compare a...
journal_title:Pain physician
pub_type: 杂志文章,评审
doi:
更新日期:2010-01-01 00:00:00
abstract:UNLABELLED:The stellate ganglion block has been utilized in a variety of painful conditions ranging from sympathetically mediated pain in the upper extremity to the pain associated with intractable angina. A number of techniques are used to block the stellate ganglion. OBJECTIVE:To describe a new and easy approach to ...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Recently, several studies suggested that radiofrequency (RF) ablation of the genicular nerves is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA). Diagnostic genicular nerve block (GNB) with local anesthetic has been generally conducted before m...
journal_title:Pain physician
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Corticosteroids have been used for the past 70 years in the treatment of various musculoskeletal conditions. This includes its use for joint pain such as rheumatoid arthritis and osteoarthritis. OBJECTIVES:A narrative review of the literature from its initial discovery to the present day to summarize the re...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Pain clinicians have always been challenged by the variability of response to pain treatment. Differences in the degree of pain stimulation and pain sensitivity, weight and age differences, prior opioid use and tolerance, as well as the differences in bioavailability of various opioid formulations have been ...
journal_title:Pain physician
pub_type: 杂志文章,评审
doi:
更新日期:2014-09-01 00:00:00
abstract::Research into interventional techniques in managing chronic spinal pain continues to be challenging, mystifying, confusing, and biased. Insight, or lack thereof, into placebo and nocebo phenomena contributes mightily to these difficulties. Unfortunately, placebo-nocebo responses are the subject of numerous controversi...
journal_title:Pain physician
pub_type: 杂志文章,评审
doi:
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Individual response to opioid analgesics varies among patients. OBJECTIVE:This study sought to clarify the impact of distinct genetic variations on pain, opioid consumption, and opioid side effects in patients with postoperative pain. STUDY DESIGN:A systematic review and meta-analysis of associations betwe...
journal_title:Pain physician
pub_type: 杂志文章,meta分析,评审
doi:
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Gonadal hormones are critical factors in modulating the experience of pain, as suggested by the several sex differences observed: women have a greater risk of many clinical pain conditions, and postoperative and procedural pain may be more severe in them than in men. A growing body of literature demonstrates...
journal_title:Pain physician
pub_type: 杂志文章,评审
doi:
更新日期:2012-07-01 00:00:00
abstract::Postlumbar laminectomy syndrome, or pain following operative procedures of the lumbar spine, is increasingly a common entity in modern medicine. Multiple causes proposed for recurrence of pain after lumbar laminectomy are: epidural fibrosis, recurrent disc herniation, instability, and facet joints. Even though the pre...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND:Over the last decade various guidelines for quality assurance in pain medicine have been published for cancer pain, acute postoperative pain and other pain conditions. However, quality assurance for interventional pain management procedures has yet to be addressed. An interventional pain program should at le...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:Chronic low back pain (CLBP) incurs huge costs owing to increased healthcare expenditure, disability, insurance, and work absenteeism. Opioid analgesics are commonly used for the management of CLBP. OBJECTIVE:To compare and rank the opioids used in the management of CLBP, in terms of efficacy and safety. S...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Metastases to the bone are common in cancer patients, and it has been estimated that up to 50% of patients with pelvic bone metastases will not achieve adequate pain control with medications alone. This has led to a paradigm shift over recent years towards the use and development of minimally invasive image-...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2017-11-01 00:00:00
abstract::A peripheral nerve stimulator (PNS) can be an alternative for long-term pain relief refractory to conventional therapeutic modalities. We present a case of chronic incapacitating ilioinguinal neuralgia, which was successfully managed with permanent implantation of a peripheral nerve stimulator. A 26-year-old active du...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:It is important to understand the anatomical relationship between the medial and lateral branches of superficial radial nerve (SRN) and the first dorsal compartment to prevent and minimize possible injury to these nerves during various procedures around the tip of radial styloid process (RSP). OBJECTIVE:To ...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2016-07-01 00:00:00
abstract::A malpractice claim or suit can have a devastating effect on a physician's practice and personal life. What is often overlooked is that an employment-related suit or EEOC charge also can extract a heavy toll, personally, professionally, and financially. The number of employment-related suits and claims has risen drama...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Certain types of cancer pain have remained hard to control even by highly skilled pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning, and leads to psychological distress. From this perspective, nonpharmacologic modalities of treatment are important. Neurom...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Pulsed radiofrequency (PRF) therapy is a clinical treatment utilizing electromagnetic energy aimed to relieve neuropathic pain. This is the first study examining the modulated expression of pain regulatory genes following the induction of the spared nerve injury (SNI) pain model and subsequently treated with...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Conventional open surgical procedures may cause massive dissections of the spine, higher perioperative complications, prolonged hospitalization, protracted rehabilitation programs and recovery. Percutaneous endoscopic lumbar interbody fusion (PELIF) is an evolving treatment option. OBJECTIVES:To present the...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Low back pain is a common worldwide health problem and has a significant socioeconomic impact on public health. Internal disc disruption has been considered as the most common cause of low back pain. Various therapies, including interbody fusion, disc replacement, injection therapies, and thermal annular pro...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. OBJECTIVE:The current investigation aimed to examine the analgesic efficacy and the opioid sparing effects of intravenous parecoxib in combination with continuous femoral blocka...
journal_title:Pain physician
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Post-dural puncture headache (PDPH) is the most common complication of procedures in which the dura mater is penetrated. OBJECTIVES:To evaluate the effectiveness of caudal saline injections as a therapeutic approach for handling post-dural puncture headache. STUDY DESIGN:Prospective observational study bet...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Epidural steroid injections are commonly used for chronic spinal pain. However, there is no conclusive evidence regarding their effectiveness, and debate continues as to their value in managing chronic spinal pain. OBJECTIVE:To evaluate various types of epidural injections (interlaminar, transforaminal, and...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2005-01-01 00:00:00
abstract::In most cases of post-dural puncture headache, the positional symptoms will resolve spontaneously within 2 weeks. Conservative therapies include oral analgesics and hydration, bed rest, and abdominal binders. For refractory cases, an autologous epidural blood patch remains the treatment of choice. However, in certain ...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2009-05-01 00:00:00
abstract:BACKGROUND:Understanding the mechanisms of long-standing musculoskeletal pain and adaptations in response to physical rehabilitation is important for developing optimal treatment strategies. The influence of central adaptations of pain perception in response to rehabilitation of musculoskeletal pain remains unclear. O...
journal_title:Pain physician
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2012-09-01 00:00:00
abstract::In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research...
journal_title:Pain physician
pub_type: 杂志文章,评审
doi:
更新日期:2013-05-01 00:00:00
abstract::The rarity of published bleeding complications with respect to the practice of interventional pain medicine suggests two possibilities: techniques are being performed in a manner to minimize bleeding or the process of hemostasis is very forgiving. Hence, bleeding complications may increase if techniques are not perfor...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:The management of chronic pain is complex and often involves the integration of multiple clinical, humanistic, and economic factors. Primary care physicians (PCPs) are often at the forefront of managing chronic pain and often initiate pharmacological pain management therapy. To date little is known surroundi...
journal_title:Pain physician
pub_type: 杂志文章
doi:
更新日期:2018-11-01 00:00:00