title: Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections.
abstract: METHODS
  A randomized, double-blind, active controlled trial.
  
  
  OBJECTIVE
  To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis.
  
  
  BACKGROUND
  Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature.
  
  
  METHODS
  One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight.
  
  
  RESULTS
  Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group.
  
  
  CONCLUSIONS
  Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Wargo
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Malla
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000187:drug effects / Q000473:pathology; D059350:Chronic Pain / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy*; D059408:Pain Management; D011843:Radiculopathy / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D013256:Steroids; D001623:Betamethasone; D008012:Lidocaine