The dosages of corticosteroid in transforaminal epidural steroid injections for lumbar radicular pain due to a herniated disc

Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, South Korea.
Pain physician (Impact Factor: 3.54). 07/2011; 14(4):361-70.
Source: PubMed


Intervertebral disc herniations are the most common cause of lumbosacral radiculopathy, and transforaminal epidural steroid injection (TFESI) is an important tool in treating lumbosacral radiculopathy. But the ideal dose of corticosteroid in the epidural management of lumbosacral radiculopathy has yet to be determined.
The aim of this study was to determine the effective dose of steroids in TFESI for pain reduction in patients with lumbosacral radiculopathy.
A randomized, double blind, controlled trial.
An interventional pain management practice center.
A total of 160 participants received 2 epidural injections of either 5 mg, 10 mg, 20 mg, or 40 mg of triamcinolone in one week intervals via TFESI. The degree of participant satisfaction and verbal numerical rating scale (VNRS) were assessed at pretreatment, one week, and 2 weeks after the first TFESI.
The number of participants experiencing pain relief was significantly less than in other groups in the 5 mg triamcinolone group at one week after the first TFESI. There were no significant differences among the groups at one week after the second TFESI. VNRS decreased in the other groups except the triamcinolone 5 mg group at one week after the first TFESI. VNRS decreased in all groups at one week after the second TFESI.
The limitations include lack of placebo control group and lack of long-term follow-up.
We recommend a minimal effective dose of corticosteroid (triamcinolone 10 mg) in TFESI for patients with lumbosacral radiculopathy.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epidural steroid injection (ESI) is the most commonly performed intervention in pain clinics across the United States. This article provides an evidence-based review of ESI, including data on efficacy, patient selection, comparison of types, and complications. The data strongly suggest that ESI can provide short-term relief for radicular symptoms but are less compelling for long-term effects or relief of back pain. Although it has been asserted that transforaminal ESIs are more efficacious than interlaminar injections, the evidence supporting this is limited.
    Current Pain and Headache Reports 11/2011; 16(1):50-9. DOI:10.1007/s11916-011-0236-9 · 2.26 Impact Factor
  • Source

    PM&R 03/2013; 5(3):230-237. DOI:10.1016/j.pmrj.2013.02.002 · 1.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neuromodulation is an effective and reversible treatment option for chronic intractable pain. Spinal cord stimulation (SCS) represents a field of application of neuromodulation and is known to be effective for several conditions including complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), and chronic leg and back pain. SCS has some technical limitations that can be bypassed through retrograde neuromodulation. To examine the safety and efficacy of retrograde neuromodulation in consecutive patients with neuropathic pain in the perineum or lower limb. Prospective chart review analyzing one year of retrograde stimulation in our department. We present a series of 10 patients who underwent retrograde neuromodulation at the University General Hospital of Valencia (Spain). We analyzed the variables that can improve the outcome and help physicians choose retrograde neuromodulation. Seven of 10 patients had an effective treatment and 3 patients had an ineffective stimulation. In the group with the effective treatment the most represented type of pain was radiculopathy and perineal pain. This is a prospective, single-center study with a relatively small number of patients and no control group. Retrograde neuromodulation seems to be effective in patients that present with a well localized pain with a clear dermatome distribution. We found retrograde neuromodulation to be effective in radiculopathy related to FBSS. We found it to be limited in the treatment of perineal pain probably due to technical limitations and anatomical reasons besides the lack of knowledge of the etiology of this pain model and the exact mechanisms of action of neuromodulation.
    Pain physician 03/2013; 16(2):145-53. · 3.54 Impact Factor
Show more