Pain Management Center of Paducah, Paducah, KY ; University of Louisville, Louisville, KY.
J Pain Res. 2012;5:301-11. doi: 10.2147/JPR.S32699. Epub 2012 Aug 24.
Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source.
在慢性腰痛的多种病因中，轴性和椎间盘源性疼痛较为常见。针对椎间盘源性和轴性腰痛，有多种治疗方法，包括硬膜外注射。然而，对于用于治疗轴性或椎间盘源性疼痛的任何治疗方法的有效性、适应证和医学必要性，包括硬膜外注射，证据有限。在美国的介入性疼痛管理实践中，进行了一项随机、双盲、活性对照试验。目的是评估腰椎间硬膜外注射局部麻醉药联合或不联合类固醇治疗椎间盘源性慢性腰痛的效果。但是，椎间盘突出症、神经根炎、小关节疼痛或骶髂关节疼痛被排除在外。研究了两组患者，每组 60 例患者分别接受局部麻醉药或局部麻醉药混合非颗粒性倍他米松。主要结局指标包括疼痛缓解（用数字评分量表评估疼痛）和功能状态（用 Oswestry 残疾指数评估）。次要结局测量包括就业状况和阿片类药物摄入量。显著改善或成功定义为疼痛和残疾至少减少 50%。第 I 组中 77%的患者和第 II 组中 67%的患者有显著改善。在成功组（前两次治疗至少缓解 3 周的患者）中，第 I 组的改善率为 84%，第 II 组为 71%。对于那些因保守治疗而导致慢性功能受限性腰痛的患者，可以认为硬膜外注射局部麻醉药联合或不联合类固醇可能是治疗慢性轴性或椎间盘源性疼痛的有效方法。对于那些已经排除了小关节和骶髂关节作为疼痛源的患者，这种治疗方法似乎是有效的。
