title: Epidural steroid injections for low back pain in rural practice: a 5-year retrospective study.
abstract: BACKGROUND
  Epidural steroid injections (ESIs) are a safe and accessible therapy for chronic low back pain, one of the most common and challenging chronic conditions seen in primary care. However, the indications for and effectiveness of ESI remain controversial. In rural settings with limited public transportation infrastructure, such a mobility-limiting condition can have even more negative effects on quality of life and function. Furthermore, diagnostic and specialist services are often limited. A paucity of safe, effective and accessible treatments leads to heavy reliance on oral analgesics, especially opioids, which have well-known complications.
  
  
  METHODS
  We reviewed the use of ESI for the 2 most common types of chronic low back pain in those with neurologic symptoms: lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). We did a retrospective chart review of all patients who underwent ESI between Jan. 1, 2005, and Feb. 25, 2010, at our rural hospital in northwestern Ontario.
  
  
  RESULTS
  During the study period, 123 ESIs were administered to 65 patients. After the first injection, 40 patients (62%) reported improvement, 10 (15%) reported worsening or no change, and 15 (23%) had no follow-up documented.
  
  
  CONCLUSIONS
  Some patients with neurologic compromise from LDH or LSS have improvement in symptoms after ESI. A prospective study is underway to more rigorously assess the effectiveness of this treatment.
authors.affiliation: Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Azad
authors.initials: A
authors.lastname: Mashari
authors.forename: Robert
authors.initials: R
authors.lastname: Minty
authors.forename: Lauren
authors.initials: L
authors.lastname: Minty
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Hopman
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D055959:Intervertebral Disc Degeneration / Q000188:drug therapy; D007405:Intervertebral Disc Displacement / Q000188:drug therapy; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018579:Patient Selection; D012189:Retrospective Studies; D012424:Rural Population; D013130:Spinal Stenosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones