Does Pain Reduction with Oral Steroids Predict Pain Reduction after a First-Time Cervical Epidural Steroid Injection in Patients with Cervical Radicular Pain? A Pilot Study.
OBJECTIVE
Oral and injected steroids are used commonly in the treatment of cervical radicular pain despite a paucity of data demonstrating their efficacy. The purpose of this study is to assess whether the response to orally administered steroids among patients with acute cervical radicular pain who develop recurrent pain is associated with their subsequent response to cervical epidural steroid injections.


METHODS
Patients referred to our center were evaluated and then referred for cervical epidural steroid injections at the clinical discretion of the provider; those who met inclusion criteria were offered participation in the study. After the injection was administered, patients were contacted by telephone and asked to complete the Brief Pain Inventory Short Form at one week, one month, three months, and six months postinjection.


RESULTS
Pain reduction after cervical steroid injection was not significantly different between 49 patients who reported pain reduction with a prior course of oral steroids and 22 patients who reported no pain reduction. Average pain scores decreased over six months (P < 0.001) among 72 patients treated with epidural steroid injection for cervical radicular pain. Of the 55 who provided baseline and six-month data, 14 (25.5%) reported complete relief at six months and 20 (36.4%) reported decreased pain.


CONCLUSIONS
Patients can be reassured that they may experience pain reduction after a cervical epidural steroid injection even if oral steroid therapy was not effective. The majority of patients treated for cervical radicular pain with epidural steroid injection have reduced or absent pain for at least six months after treatment.
Department of Anesthesiology and Pain Management, Maine Medical Center, Portland, Maine.
Dana G
DG
Crovo
Maine Medical Center Research Institute, Portland, Maine, USA.
Wendy Y
WY
Craig
Department of Anesthesiology and Pain Management, Maine Medical Center, Portland, Maine.
Craig S
CS
Curry
Department of Anesthesiology and Pain Management, Maine Medical Center, Portland, Maine.
Janelle M
JM
Richard
Department of Anesthesiology and Pain Management, Maine Medical Center, Portland, Maine.
James V
JV
Pisini
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010865:Pilot Projects; D011843:Radiculopathy / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
D000700:Analgesics; D013256:Steroids
cervical; epidural; pain; radicular; steroid