Featured Research

from universities, journals, and other organizations

Transforaminal vs. Interlaminar epidural steroid injections: Both offered similar pain relief, function for radiating low-back pain

Date:
March 6, 2014
Source:
American Academy of Pain Medicine (AAPM)
Summary:
Two commonly delivered epidural injection modalities deliver minimal differences in pain relief and function at 1 and 6 months, new research shows. Results indicate both injection types were effective for treating unilateral lumbosacral radicular pain (ULSRP).

Two commonly delivered epidural injection modalities deliver minimal differences in pain relief and function at 1 and 6 months, new research shows. Results presented today at the 30th Annual Meeting of the American Academy of Pain Medicine indicate both injection types were effective for treating unilateral lumbosacral radicular pain (ULSRP).

"These results suggest that the difference in efficacy between these 2 modalities may be less significant than previously thought," said lead study author George Chang Chien, DO, of the Rehabilitation Institute of Chicago, Ill. "Some slight differences were found earlier in the treatment process."

Low-back pain that radiates to a lower extremity (i.e., ULSRP) is a challenging condition to treat. Epidural injections, which deliver steroids into the epidural space around spinal nerve roots to reduce inflammation and pain, are commonly used in the United States, although assessing their effectiveness has proved difficult due to variations in techniques and patient selection, among other factors (Manchikanti et al, Pain Physician 2013; 16:E349-64).

Mindful of the lack of studies that compare treatments, investigators performed a systematic literature review to assess pain relief and functional improvement in transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) for ULSRP. During TFESI, a long-acting steroid is injected into the opening at the side of the spine where a nerve roots exits, known as the neuroforamen. During ILESI, an injection is delivered to the dorsal epidural space between the lamina of the vertebrae.

"It is thought that TFESI provides better results due to the close deposition of medication to the site of nerve entrapment, " Dr. Chang Chien said. "Yet, existing studies have shown conflicting results. This review assessed all the high quality studies that directly compared the 2 commonly performed interventions."

Studies met the Cochrane Review criteria for randomized trials and the Agency for Healthcare Research and Quality criteria for observational studies. Five studies assessed were prospective and 3 were retrospective, altogether encompassing 506 patients. A difference in pain reduction of ≥20% and functional score improvement of ≥10% were considered clinically significant.

At 2 weeks, TFESI was superior to ILESI in pain relief by 15%. However, at 1 or 6 months, no difference was found. Furthermore, combining pain improvements from all 5 prospective studies revealed < 20% difference between TFESI and ILESI (54.1% vs. 42.7%).

Results comparing functional improvements between groups showed slight superiority for ILESI (56.4%) vs. TFESI (49.4%) at 2 weeks and very slight differences for combined data (TFESI 40.1% and ILESI 44.8%).

Current practice trends have demonstrated a shift away from interlaminar epidural steroid injections, toward the increasingly more widespread practice of the transforaminal approach (Manchikanti et al, Pain Physician 2013; 16:E349-64).

"In part, this is due to the belief of superior efficacy," Dr. Chang Chien explained. "This perceived superiority of TFESI is accompanied by potential additional risks, likely to be much less common with ILESI, such as intradiscal and intravascular injection with the attendant sequelae."

Most complications from epidural injections are minor, but some can be serious, including the potential for neurological damage (Chang Chien et al, Pain Physician 2012; 15: 515-23). This begs the question as to whether the increased risk of potential catastrophic morbidity is effectively offset by the minimal differences in efficacy between the 2 respective approaches.

"Future well-designed studies are necessary to confirm the findings of this systematic review," said Dr. Chang Chien. "We are in the process of starting this study soon."


Story Source:

The above story is based on materials provided by American Academy of Pain Medicine (AAPM). Note: Materials may be edited for content and length.


Cite This Page:

American Academy of Pain Medicine (AAPM). "Transforaminal vs. Interlaminar epidural steroid injections: Both offered similar pain relief, function for radiating low-back pain." ScienceDaily. ScienceDaily, 6 March 2014. <www.sciencedaily.com/releases/2014/03/140306211032.htm>.
American Academy of Pain Medicine (AAPM). (2014, March 6). Transforaminal vs. Interlaminar epidural steroid injections: Both offered similar pain relief, function for radiating low-back pain. ScienceDaily. Retrieved September 19, 2014 from www.sciencedaily.com/releases/2014/03/140306211032.htm
American Academy of Pain Medicine (AAPM). "Transforaminal vs. Interlaminar epidural steroid injections: Both offered similar pain relief, function for radiating low-back pain." ScienceDaily. www.sciencedaily.com/releases/2014/03/140306211032.htm (accessed September 19, 2014).

Share This



More Health & Medicine News

Friday, September 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Cost of Ebola

The Cost of Ebola

Reuters - Business Video Online (Sep. 18, 2014) As Sierra Leone prepares for a three-day "lockdown" in its latest bid to stem the spread of Ebola, Ciara Lee looks at the financial implications of fighting the largest ever outbreak of the disease. Video provided by Reuters
Powered by NewsLook.com
What HealthKit Bug Means For Your iOS Fitness Apps

What HealthKit Bug Means For Your iOS Fitness Apps

Newsy (Sep. 18, 2014) Apple has delayed the launch of the HealthKit app platform, citing a bug. Video provided by Newsy
Powered by NewsLook.com
U.S. Food Makers Surpass Calorie-Cutting Pledge

U.S. Food Makers Surpass Calorie-Cutting Pledge

Newsy (Sep. 18, 2014) Sixteen large food and beverage companies in the United States that committed to cut calories in their products far surpassed their target. Video provided by Newsy
Powered by NewsLook.com
Residents Vaccinated as Haiti Fights Cholera Epidemic

Residents Vaccinated as Haiti Fights Cholera Epidemic

AFP (Sep. 18, 2014) Haitians receive the second dose of the vaccine against cholera as part of the UN's vaccination campaign. Duration: 00:34 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins