Injection Therapy for Subacute and Chronic Benign Low Back Pain

Department of Epidemiology, University of Maastricht, The Netherlands.
Spine (Impact Factor: 2.3). 04/2001; 26(5):501-15. DOI: 10.1097/00007632-200103010-00014
Source: PubMed


The Medline and Embase databases containing randomized controlled trials of injection therapy published to 1998 were systematically reviewed.
To evaluate the effectiveness of injection therapy with anesthetics, steroids, or both in patients with low back pain persisting longer than 1 month.
Two reviewers independently assessed the trials for the quality of their methods. The primary outcome measure was pain relief. Subgroup analyses were performed between trials with different control groups (placebo and active injections), with different injection sites (facet-joint, epidural, and local injections), and with timing of outcome measurement (short- and long-term). Within the resulting 12 (2 x 3 x 2) subcategories of studies, the overall relative risks and corresponding 95% confidence intervals were estimated, using the random effects model of DerSimonian and Laird. In the case of trials using active injections as a control, the results were not pooled.
This review included 21 randomized trials. All the studies involved patients with low back pain persisting longer than 1 month. Only 11 studies compared injection therapy with placebo injections (explanatory trials). The methodologic quality of many studies was low: Only eight studies had a methodologic score of 50 points or more. There were only three well-designed explanatory clinical trials: one on injections into the facet joints with a short-term relative risk of 0.89 (95% confidence interval = 0.65-1.21) and a long-term relative risk of 0.90 (95% confidence interval = 0.69-1.17), one on epidural injections with a short-term relative risk of of 0.94 (95% confidence interval = 0.76-1.15) and a long-term relative risk of 1.00 (95% confidence interval = 0.71-1.41), and one on local injections with a long-term relative risk of 0.79 (95% confidence interval = 0.65-0.96). Within the six subcategories of explanatory studies, the pooled relative risks were as follows: facet joint, short-term: relative risk = 0.89 (95% confidence interval = 0.65-1.21); facet joint, long-term: relative risk = 0.90 (95% confidence interval = 0.69-1.17); epidural, short-term: relative risk = 0.93 (95% confidence interval = 0.79-1.09); epidural, long-term: relative risk = 0.92 (95% confidence interval = 0.76-1.11); local, short-term: relative risk = 0.80 (95% confidence interval = 0.40-1.59); and local, long-term: relative risk = 0.79 (95% confidence interval = 0.65-0.96).
Convincing evidence is lacking regarding the effects of injection therapy on low back pain. Additional well-designed explanatory trials in this field are needed.

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    • "Effect of facet joint injection in lumbar spinal stenosis: Experience of Rheumatology Hospital Unit of Cotonou (Benin), The Egyptian Rheumatologist (2013), In all studies, the overall decrease in pain intensity is used as the main criterion, but with great variability both in quantitative terms (significant relief: 33%, 50%, 75%) and in terms of quality, which makes comparisons difficult [12] [13] [14] [15]. "
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    ABSTRACT: Aim of the work To evaluate the effect of facet joint injection in patients with lumbar spinal stenosis due to facet joint arthrosis in the Rheumatology Department of National Hospital University-Hubert Koutoukou Maga of Cotonou (Benin). Patients and methods A prospective case-control study was conducted from January 2011 to June 2013. The selected patients suffered from lumbar spinal stenosis due to facet joint arthrosis and received two corticosteroid facet joint injections at two week intervals compared to the control-group with the same disease. Demographic data, clinical parameters and outcomes in six months were collected. The primary endpoint was the reduction of visual analogue score (VAS) for pain. Results Sixty-four patients received a facet joint injection against 65 patients in the control group. The mean age was 67.03 ± 12.1 and 66.02 ± 13.7 and the sex ratio was 0.64 and 0.71, respectively in the “injection group” and “control group.” All patients had a VAS > 4. At one, three and six months, 53 (82.2%), 41 (64.06) and 26 (40.62) patients had, respectively more than 75% pain reduction against 27 (41.53%), 15 (23.08) and 7 (10.77) patients in the control group (p < 0.01). Patients in the injection group were five times more improved than the control group at six months with OR = 5.67 95% CI [2.07, 6.16]. Conclusion This work shows the effectiveness of facet joint injections to relieve pain due to facet joint arthrosis that continued at six months of follow up.
    Egyptian Rheumatologist 01/2013; 36(2). DOI:10.1016/j.ejr.2013.10.001
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    • "Other activities in daily life appeared to show improvement according to pain reduction. Therefore, the effectiveness of facet joint injections for treating low-back pain corresponded with the results of earlier studies.13 No significant differences in the VAS, PhyGA, PaGA, and MODI were observed between the groups. "
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    ABSTRACT: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections. Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure. Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p<0.05). However at a week, a month, and three months after injections, no significant differences were observed between the groups with regard to VAS, PhyGA, PaGA, and MODI (p>0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7±6.5 sec; US: 263.4±5.9 sec; p=0.023). US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.
    Annals of Rehabilitation Medicine 02/2012; 36(1):66-71. DOI:10.5535/arm.2012.36.1.66
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    • "These side effects and adverse effects are similarly reported on other injection methods commonly used in the spine such as facet joint block, epidural block and local injection.7-10 Also, complications from invasive injection modality can occur irrespective of the drug being injected.3 "
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    ABSTRACT: A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.
    Annals of Rehabilitation Medicine 08/2011; 35(4):570-3. DOI:10.5535/arm.2011.35.4.570
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