Int J Med Sci 2012; 9(6):424-434. doi:10.7150/ijms.4444
Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections
1. Medical Director of the Pain Management Center of Paducah, Paducah, KY and Clinical Professor, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
2. Research Coordinator at the Pain Management Center of Paducah, Paducah, KY, USA
3. Statistician at the Pain Management Center of Paducah, Paducah, KY, USA
4. Was an Interventional Pain Physician at the Pain Management Center of Paducah, Paducah, KY. He is presently at The McFarland Clinic, Mary Greeley Medical Center, Ames, IA, USA
5. Interventional Pain Physician at the Pain Management Center of Paducah, Paducah, KY, USA.
Study Design: A randomized, double-blind, active controlled trial.
Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis.
Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature.
Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone.
Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight.
Results: Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group.
Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis.
Keywords: Chronic neck pain, cervical disc herniation, upper extremity pain, cervical epidural injections, epidural steroids, local anesthetics
Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections. Int J Med Sci 2012; 9(6):424-434. doi:10.7150/ijms.4444. Available from http://www.medsci.org/v09p0424.htm