Title: Comparison of Epidural Steroid and Gabapentinin Lumbosacral Pain

Authors: Dr Vishal Moudgil, Dr Baljit Singh Bajwa

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i3.57

Abstract

Purpose: To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy in 150 patients.

Material and methods: A  prospective intervention study was done on 150 patients with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration which may be associated with leg pain .Patients received either epidural steroid injection or gabapentin. The patient was evaluated according to the Oswestry disability index, which is a 10 question survey used to assess function in people with low back and/or leg pain. Pre and post treatment ODI was compared .The follow up was done monthly till 3 months.

Conclusions Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.

Keywords: epidural, low back pain, gabapentin, disability, injection, spinal, Oswestry disability index

References

 1.      US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.JAMA2013;310:591-608.

2.      Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum2012;64:2028-37.

3.      Juniper M, Le T, Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother2009;10:2581-92.

4.      Cohen SP, Mao J. Mechanisms of neuropathic pain and their clinical implications. .   BMJ2014;348:f7656.

5.      Manusov EG (September 2012). "Evaluation and diagnosis of low back pain". Prim. Care 39 (3):            4719. doi:10.1016/j.pop.2012.06.003.PMID 22958556.

6.      Cohen SP, Argoff CE, Carragee EJ (2008). "Management of low back pain". BMJ337: a2718. doi:10.1136/bmj.a2718. PMID 19103627

7.      Koes, BW; van Tulder, M; Lin, CW; Macedo, LG; McAuley, J; Maher, C (December 2010). "An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.". European Spine Journal 19 (12): 2075–94.doi:10.1007/s00586-010-1502-y. PMID 20602122

8.      Manchikanti L, Falco FJ, Singh V, et al. Utilization of interventional techniques in managing chronic pain in the Medicare population: analysis of growth patterns from 2000 to 2011. Pain Physician2012;15:E969-82.

9.      Cohen SP, Jamison D, Bicket M, et al. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med2013;38:175-200

10.  Hopwood M, Abram S. Factors associated with failure of lumbar steroids. Reg Anes1993;18:238-43

11.  Romano CL, Romanò D, Bonora C, et al Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthopaed Traumatol2009;10(4):185-91.

12.  Baron R, Martin-Mola E, Müller M, et al. Effectiveness and safety of tapentadol prolonged release (PR) versus a combination of tapentadol PR and gabapentinfor the management of severe, chronic low back pain with a neuropathic component: a randomized, double-blind, phase 3b study. Pain Pract2014;doi:10.1111/papr.12200

13.  Baron R, Freynhagen R, Tölle TR, et al; A0081007 Investigators. The efficacy and safety of gabapentinin the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain2010;150:420-7.

14.  Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med2012;157:865-77.

15.  Brouwers MC, Thabane L, Moher D, et al. Comparative effectiveness research paradigm: implications for systematic reviews and clinical practice guidelines. J Clin Oncol2012;30:4202-7

16.  Laiq N, Khan MN, Iqbal MJ, et al. Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy. J Coll Physicians Surg Pak2009;19:539-43

17.  Dincer U, Kiralp MZ, Cakar E, et al. Caudal epidural injection versus non-steroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine2007;74:467-71

18.  Cohen SP, Hayek S, Semenov Y, et al. Epidural steroid injections, conservative treatment or combination treatment for cervical radiculopathy: a multi-center, randomized, comparative-effectiveness study. Anesthesiology2014;121:1045-55.

19.  Friedly JL, Comstock BA, Turner JA,  Heagerty PJ, Deyo RA, Sullivan SD,et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med2014;371:11-21.

20.  Steven P Cohen, Steven Hanling, Mark C Bicket, Ronald L White, Elias Veizi, Connie Kurihara et al. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study . BMJ 2015;350:h1748

Corresponding Author

Bajwa BS

71-72 Tower Enclave Phase 3,

Lane No. 5 Jualandhar Punjab India