Spinal Diagnostics and Treatment Center, California, USA.
Pain Med. 2010 Sep;11(9):1335-42. doi: 10.1111/j.1526-4637.2010.00930.x. Epub 2010 Aug 23.
There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs.
We anticipated and sought to confirm that injecting local anesthetic in intervertebral discs would provide convincing pain relief and that the degree of pain relief would help confirm or refute the findings of provocative discography.
There were 23 patients in the nonanalgesic group, and 47 patients in the analgesic group. The analgesic patient discs were injected with an equal volume of local anesthetic and nonionic contrast media. Lumbar discography was performed using an automated pressure-controlled provocative discographic (APCPD) technique. Subjects reported global subjective relief at 15 and 45 minutes after APCPD. Pre- and post-procedure pain was rated using a numerical rating scale (NRS) using standardized pain provoking positions. In addition, we further compared the numbers of patients reporting a decrease in NRS scores (≥2) in standardized pain provoking positions.
The addition of local anesthetic to APCPD did not affect the number of positive APCPD results that averaged ∼30% positive discs in both groups. The addition of local anesthetic to contrast significantly reduced pain NRS scores by 2/10 or greater during forward flexion and sitting compared with patients whose discs were injected with contrast without local anesthetic. The average pain improvement using standardized pain provocation positions and average subjective relief were not, however, significantly different in the two groups. Only two patients reported overall pain relief equal or greater to 50%.
Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort.
有重新对镇痛测试的兴趣，受几项研究的影响，这些研究报告称，当通过在疼痛椎间盘内注射局部麻醉剂以缓解疼痛来确认椎间盘源性疼痛的诊断时，手术结果非常显著。
我们预期并寻求确认向椎间盘内注射局部麻醉剂将提供令人信服的疼痛缓解，并且疼痛缓解的程度将有助于确认或反驳有创椎间盘造影术的发现。
非镇痛组有 23 名患者，镇痛组有 47 名患者。镇痛患者的椎间盘注射等量的局部麻醉剂和非离子型造影剂。采用自动压力控制激发性椎间盘造影术（APCPD）技术进行腰椎间盘造影术。在 APCPD 后 15 和 45 分钟，患者报告了整体主观缓解。使用数字评定量表（NRS）在标准疼痛诱发位置之前和之后进行疼痛评估。此外，我们还进一步比较了在标准疼痛诱发位置报告 NRS 评分（≥2）下降的患者人数。
向 APCPD 添加局部麻醉剂不会影响 APCPD 的阳性结果数量，两组中平均有∼30%的阳性椎间盘。与向椎间盘内注射不含局部麻醉剂的造影剂的患者相比，向椎间盘内注射局部麻醉剂和造影剂会显著降低前屈和坐姿时的疼痛 NRS 评分 2/10 或更多。然而，两组在使用标准疼痛诱发位置的平均疼痛改善和平均主观缓解方面没有显著差异。只有两名患者报告整体疼痛缓解等于或大于 50%。
与单独使用造影剂相比，在一组患者中向激发性椎间盘造影术中注射等量的局部麻醉剂和造影剂并没有提供显著的整体主观疼痛缓解。
