title: The use of epidural steroid injection and manipulation on patients with chronic low back pain.
abstract: OBJECTIVE
  To document the efficacy of combined epidural steroid injection (ESI) and manipulation to the lumbar spine in patients suffering from chronic low back pain (LBP).
  
  
  BACKGROUND
  The use of ESI in conjunction with lumbar manipulation has seldom been reported in the literature but has offered promising results when studied.
  
  
  METHODS
  Retrospective repeated-measures analysis of patients with chronic LBP who received ESIs combined with spinal manipulation.
  
  
  METHODS
  A retrospective analysis using a repeated-measures format was performed on 17 cases of patients who had received ESI and manipulation to the lumbar spine. All patients were medically stable for chronic mechanical LBP and had experienced a suboptimal response to conventional care. The principle investigator was blinded from data outcomes when determining patient eligibility for the study. A subjective patient improvement scale was used to monitor degree of success.
  
  
  RESULTS
  Ten of the 17 patients were eligible for the study. Patients were eliminated for lack of consistency of data collection, having received an additional procedure after conventional care, involvement of the cervical spine; one patient experienced an unrelated medical problem. After 1 yr of conventional care, the patients reported a 25.5% improvement. (Conventional care included ESI and manipulation done at separate times.) After on ESI with subsequent manipulation, these same patients reported a 50.5% improvement. Mean improvement was 25.00% (SD = 19.51, SEM 6.19, t = 4.04 and p = .0015).
  
  
  CONCLUSIONS
  The use of ESI performed with manipulation seems to offer promise for a carefully selected group of patients. ESI combined with manipulation should be considered in patients who do not respond to conventional forms of care.
authors.affiliation: National College of Chiropractic, Lombard, IL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Nelson
authors.forename: D
authors.initials: D
authors.lastname: Aspegren
authors.forename: C
authors.initials: C
authors.lastname: Bova
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001623:Betamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D002684:Chiropractic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D001623:Betamethasone