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Efficacy of Epidural Steroid Injections in Management of ChronicLow Back Pain.

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Abstract (2. Language): 
Introduction: Low back pain is most common complaint of young adults in case of herniated disc. Incidence is high in our country due to difficult working and living environment. Most commonly used initial treatment modality is simple, effective epidural steroid injection. The aim of this study is to assess the effectiveness of epidural steroid injection in low back pain. Material and Method: This is prospective observational study. It was carried on the patients presenting with low back pain to pain clinic not responding to conservational management and had MRI proven lumbar disc prolapsed at different level. Injection methyl prednisolone 80 mg with 2ml of 0.5% bupivacaine was diluted in 8ml of normal saline and injected into the lumbar epidural space. Fifty six patients received epidural steroid injection, among them three patients did not- come for follow up for six months and six patients required surgery.The remaining fourty seven patients were analyzed, among them 27 (55.44%) were male and 20 (42.55%) female. The functional status and pain response of patients was improved significantly during the follow up period. The success rate of study was 83.92 %. No complications were occurred.
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REFERENCES

References: 

1. Keith DW, Ashley LP. Low back pain and disorders of intervertebral discs. S. Terry Canale,
editor- Campbell's operative orthopaedics Vol III. 9th ed. Mosby, 2003: 3014-80.
2. Peng B, Wu W, Li Z, et al. Chemical radiculitis. Pain 2007;127:11–6.
3. Mulleman D, Mammou S, Griffoul I, et al. Pathophysiology of disc-related sciatica. I– Evidence
supporting a chemical component. Joint Bone Spine 2006;73:151–8.
4. Kawakami M, Tamaki T, Hayashi N, et al. Possible mechanism of painful radiculopathy in
lumbar disc herniation. Clin Orthop Relat Res 1998;351:241–51.
5. Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the man agement of chronic spinal
pain: a systematic review. Pain Physician 2007;10:185-212.
6. Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician.
2002;5:182-199.
7. Abdi S, Datta S, Trescot AM et al. Epidural steroids in the management of chronic spinal pain:
a systematic review. Pain Physician 2007; 10: 185-212.
8. Cuckler JM, Bernini PA, Wiesel SW, Booth RE, Rothman RH, Pickens GT. The use of epidural
steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.
J Bone Joint Surg Amer 1985; 67: 63-6.
9. Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy.
Pain 1986; 24: 277-95.
10. GlennR. Buttermann.Treatment of lumbar disc herniation :epidural steroid injection
Compared with discectomy: a prospective randomized study. J Bone Joint Surg 2004; 86: 670-9.
11. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25: 2940-53.
12. Davidson M, Keating J. A comparison of five low back disability questionnaires: reliability
and Responsiveness. Physical Therapy 2002; 82: 8-24.
13. RobecchiA, Capra R. Hydrocortisone; first clinical experiments in the field of rheumatology.
Minerva Med 1952; 43: 1259-63.
14. Boswell M, Hansen H, Trescot A, Hirsch J. Epidural steroids in the management of chronic
spinal pain and radiculopathy. Pain Physician 2003; 6: 319-334.
909
Indian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P. 903-911
907
www.ijbamr.com
15. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low
back pain and sciatica: a systematic review of randomized clinic Pain 1995; 63: 279-88.
16. Botwin KP et al. Fluoroscopically guided lumbar transforaminal epidural steroid injections
in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehab 2002;81(12): 898-905.
17. Thomas E, Cyteval C, Abiad L et al. Efficacy of transforaminal versus interspinous
Corticosteroid injection in discal radiculalgia: a prospective, randomized, double-blind study.
Clin Rheumatol 2003; 22: 299-304.
18. Botwin KB, Gruber RD, Bouchlas CG et al. Fluoroscopically guided lumbar Transforaminal
epidural steroid injection in degenerative lumbar stenosis. An outcome study. Am J Phys Med
Rehabil 2002; 81: 898-905.
19. Anwar A, Zaidah I, Rozita R. Prospective randomized single blind study of epidural steroid
injection comparing triamcinolone acetonide with methylprednisolone acetate. APLAR
J Rheumatology 2005; 8: 1-53
20. Blankenbaker DG, De Smet AA, Stanczak JD, Fine JP. Lumbar radiculopathy: Treatment with
selective nerve root blocks : comparison of effectiveness of triamcinolone and betamethasone
injectable suspensions. Radiology 2005; 237: 738- 741.
21. Bogduk N. Epidural steroids for low back pain and sciatica. Pain Digest 1999; 9: 226-7
22. Koes BW, Scholten RJPM, Mens JMA, Bouter LM. Efficacy of Epidural steroid injections For
low-back pain and sciatica:a systematic review of randomized clinical trials. Pain 1995; 63: 279-
88.
23. Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar
nerve root compression.Brit Med J 1973; 2: 635-7.
24. Yates DW. A comparison of the types of epidural injection commonly used in the treatment
of low back pain and sciatica. Rheumatol Rehabil 1978; 17: 181-6.
25. Maher CG. Effective Physical Treatment for Chronic LowBack Pain. Ashish D. Diwan, Safdar
N. Khan Ortho Clin North Amer 2004: 57-64.
26. Spangfort EV, The lumbar disc herniation. A computer-aided analysis of 2,504 operations.
Acta Orthop Scand 1972; 142: 1-95.
27. Yabuki S, Kawaguchi Y, Nordborg C, Kikuchi S, Rydevik B, Olmarker K. Effects of lidocaine
on nucleus pulposus-induced nerve root injury. A neurophysiologic and histologic study of
the pig cauda equina. Spine 1998; 23: 2383-9.
28. Beliveau P. A comparison between epidural anesthesia with and without corticosteroid in the
treatment of sciatica. Rheumatol Phys Med 1971; 11: 40-45.
910
Indian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P. 903-911
908
www.ijbamr.com
29. Flower RJ, Blackwell GJ. Anti-inûammatory steroids induce biosynthesis of a phospholipase
A2 inhibitor which prevents prostaglandin generation. Nature 1979; 278: 456-9.
30. Devor M, Govrin-Lippmann R, Raber P. Corticosteroids suppresses ectopic neural discharge
originating in experimental neuromas. Pain 1985; 22: 127-37.
31. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in
normal nociceptive C-ûbres. Acta Anaesthesiol Scand 1990; 34: 335-8.
32. Swerdlow M, Sayle–Creer W. A study of extradural medication in the relief of lumbosciatic
syndrome. Anesth 1970; 25: 341.
33. Winnie AP, Hartman JT, Meyers HL, Ramamurthy S,Barangan V. Pain clinic II:intradural
and extradural corticosteroids in sciatica. Anesth Analg 1972; 51: 990.

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