title: [Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits. A randomized, double blind study as part of a multimodal treatment concept].
abstract: BACKGROUND
  Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome.
  
  
  METHODS
  A double blind randomized prospective trial was carried out. Patients treated in hospital for a chronic lumbar pain syndrome without neurological deficits within a multimodal treatment program were screened for indications for an epidural steroid injection (e.g. diseased lumbar disc and intention to treat). Patients eligible for the study were randomized into two groups. The treatment group received an epidural injection of 80 mg triamcinolone and 8 ml bupivacaine 0.25 %. The control group received only an epidural injection of 8 ml bupivacaine 0.25 %.
  
  
  RESULTS
  In both groups pain intensity and treatability showed a statistically significant improvement after the epidural injection. The differences between the control and treatment groups were small and not clinically relevant. A small subgroup might profit from the steroid injection. In addition the treatability was dependent on psychometric values and the long-term outcome from a reduction of muscular skeletal dysfunctions.
  
  
  CONCLUSIONS
  After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.
authors.affiliation: Klinik für Manuelle Therapie Hamm, Ostenallee 83, 59071, Hamm, Deutschland, kay.niemier@kmt-hamm.de.
authors.forename: K
authors.initials: K
authors.lastname: Niemier
authors.forename: M
authors.initials: M
authors.lastname: Schindler
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.forename: K
authors.initials: K
authors.lastname: Baum
authors.forename: B
authors.initials: B
authors.lastname: Wolf
authors.forename: J
authors.initials: J
authors.lastname: Eberitsch
authors.forename: W
authors.initials: W
authors.lastname: Seidel
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D015299:Discitis / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D057194:Intention to Treat Analysis; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D026741:Physical Therapy Modalities; D015990:Placebo Effect; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013450:Sulfones / Q000627:therapeutic use; D013993:Tilidine / Q000627:therapeutic use; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D011725:Pyridines; D013450:Sulfones; D014221:Triamcinolone; D010098:Oxycodone; D013993:Tilidine; D000077613:Etoricoxib; D002045:Bupivacaine