Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review.
Low back pain and sciatica have been treated with peridural local anesthetics for over 80 years and with epidural and subarachnoid steroid injections for a quarter of a century. This review surveyed the literature concerning the evolution, pathophysiology, complications and results of this type of therapy. The volume injected and the method used vary with different physicians and no standard has been established. Good results from this treatment which vary from 20 to 95% decrease on long-term follow up. Statistical significance is absent if compared with other forms of therapy. It is the authors' opinion that the rationale for the use of spinal local analgesics or steroids or intramuscular steroids has not been scientifically proven. Complications with the use of subarachnoid steroids are sufficiently serious that this form of therapy should be condemned. In this age of accountability it is imperative that therapies with questionable benefits should be critically evaluated.
Kepes
Edith R
ER
Albert Einstein College of Medicine, Pain Treatment Center, Montefiore Medical Center, and Albert Einstein College of Medicine, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY 10467 U.S.A.
Duncalf
Deryck
D
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications; D009408:Nerve Compression Syndromes / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D013256:Steroids