Study Shows No Standardized Approach to Epidural Steroid Injections for Back Pain

HONOLULU, Jan. 28 /PRNewswire/ — Today at the American Academy of Pain
Medicine’s 25th Annual Meeting, researchers from University of California at
San Diego report that no standardized practices exist for administering an
epidural steroid injection for back pain. Researchers looked at many factors
including: which steroids were given, the amount of steroid used, and whether
or not a local anesthetic was mixed with the steroid.

Epidural steroid injections (ESI) are minimally invasive procedures used
to treat pain in the neck, arms, back and legs caused by inflamed nerves.
While injections in the lumbar (low back) region are low risk, injections in
the thoracic (mid back) and cervical (neck) region have the risk of injury to
the spinal cord and brain. It usually consists of a steroid diluted with
sterile saline, and sometimes also addition of local anesthesia. Controversy
exists on the long-term efficacy of this procedure to treat spine associated
pain.

To compare currently taught techniques, Yogesh Patel, MD, and his
colleagues at UCSD, identified and surveyed attending pain physicians at
interventional pain programs in the United States about their protocols
regarding ESI. Results showed that no standard protocols with regard to type
of steroid, dose or use of local anesthesia exist. In fact, the data showed
that while most physicians use a moderate volume and dose of steroid, some
physicians are giving very high volumes (up to 10 cc) of steroids in areas
such as the cervical epidural space. In limited enclosed areas like the
cervical region that volume of medicine could lead to increased pressures
which could potentially be painful for patients.

“Epidural steroid injections are an important and common option for the
treatment of back pain. However, we found that a great variety of techniques
are being used. There is no gold standard,” said Dr. Patel, lead author of
the study and resident at the University of California at San Diego.
“Guidelines may need to be explored with regard to this procedure to increase
the effectiveness and decrease risk when using this approach to treat pain.”

Dr. Patel’s study found there were differences from institution to
institution regarding which steroid was preferred for these injections. The
most common steroids identified for this procedure and respective dose ranges
were: depomedrol (dose range 40-120 mg), celestone (dose range 6-15 mg),
decadron (dose range 4-12 mg), and kenalog (dose range 10-80 mg).

“These variations in technique might affect why some patients get better
results from ESI than others and may also explain good and poor outcomes.
This needs to be explored further,” Patel concluded.

    Poster Session Information (Poster 142)
    Begins: 3:30 PM (Hawaiian Time), Wednesday, January 28, 2009
    Ends: 10:00 AM (Hawaiian Time), Thursday, January 29, 2009
    Location: Coral Ballroom Foyer, Hilton Hawaiian Village

About the AAPM

For more than 25 years, the American Academy of Pain Medicine (AAPM) has
been the medical specialty society representing more than 2,200 physicians
practicing in the field of pain medicine. The Academy is involved in
education, training, advocacy and research in the specialty of pain medicine.
Information is available on the practice of pain medicine at
http://www.painmed.org.

SOURCE American Academy of Pain Medicine