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Study Shows No Standardized Approach to Epidural Steroid Injections for Back Pain
Date:1/28/2009

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
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SOURCE American Academy of Pain Medicine
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