A Comparative Study on Low Back Pain with Radiculopathy treated with Conventional NSAIDs versus Combination of Caudal Epidural Steroid Injections and NSAIDs
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/042Keywords:
Low Back Pain, Radiculopathy, Degenerative Joint Disease, NSAIDSAbstract
Background:
Low back pain (LBP) with radiculopathy is a common, debilitating condition that adversely affects patients' quality of life and imposes a significant economic burden on healthcare systems. While NSAIDs are widely used for pain relief, their limited effectiveness in managing radicular pain highlights the need for adjunctive therapies such as caudal epidural steroid injections (CESIs). This study compares the effectiveness of NSAIDs alone versus a combination of NSAIDs and CESIs for managing LBP with radiculopathy, focusing on degenerative joint disease (DJD), acute disc prolapse (ADP), and paraspinal muscle spasm (PSMS).
Method:
A randomized controlled trial was conducted, including 100 adult patients diagnosed with LBP and radiculopathy confirmed by MRI. Participants were randomized into two groups: NSAIDs alone and NSAIDs combined with CESIs. Pain relief was assessed at one and three weeks using the Numeric Pain Rating Scale (NRS). Statistical analyses were conducted with chi-square tests, using p ≤ 0.05 as the threshold for significance.
Results:
Patients with DJD experienced significantly greater pain relief with the combination therapy. By the third week, 94.1% of DJD patients receiving CESIs with NSAIDs reported significant or complete pain relief compared to 58.3% in the NSAIDs-alone group (p < 0.05). No significant differences were observed between the groups for ADP or PSMS (p > 0.05).
Conclusions:
CESIs combined with NSAIDs are superior for managing DJD-related LBP, while NSAIDs alone may suffice for ADP and PSMS. Personalized treatment strategies are recommended based on underlying pathology.
Keywords:
Low back pain, radiculopathy, degenerative joint disease, acute disc prolapse, paraspinal muscle spasm, NSAIDs, caudal epidural steroid injections.
References
de Souza IM, Sakaguchi TF, Yuan SL, Matsutani LA, do Espírito-Santo AS, Pereira CA, Marques AP. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo, Brazil). 2019 Oct 28;74(15):789-104. https://doi.org/10.6061/clinics/2019/e789
Reimer M, Witthöft J, Greinacher J, Sachau J, Forstenpointner J, Hüllemann P, Binder A, Gierthmühlen J, Baron R. Sensory profiles in patients with low back pain with and without radiculopathy. Pain Medicine. 2023 Mar 1;24(3):306-15. https://doi.org/10.1093/pm/pnac129
Anderson DB, Shaheed CA. Medications for treating low back pain in adults. Evidence for the use of paracetamol, opioids, nonsteroidal anti-inflammatories, muscle relaxants, antibiotics, and antidepressants: an overview for musculoskeletal clinicians. journal of orthopaedic & sports physical therapy. 2022 Jul;52(7):425-31. doi/10.2519/jospt.2022.10788
Patel HD, Uppin RB, Naidu AR, Rao YR, Khandarkar S, Garg A. Efficacy and safety of combination of NSAIDs and muscle relax Pain Ther (2019) 8:121–132 https://doi.org/10.1007/s40122-019-0112-6
Park SC, Kang MS, Yang JH, Kim TH. Assessment and nonsurgical management of low back pain: a narrative review. The Korean Journal of Internal Medicine. 2023 Jan;38(1):16. doi: 10.3904/kjim.2022.250
Machado GC, Abdel-Shaheed C, Underwood M, Day RO. Non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain. BMJ. 2021 Jan 29(4);372-78. doi: https://doi.org/10.1136/bmj.n104
Sohail R, Mathew M, Patel KK, Reddy SA, Haider Z, Naria M, Habib A, Abdin ZU, Chaudhry WR, Akbar A. Effects of non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective NSAIDs on the gastrointestinal tract: a narrative review. Cureus. 2023 Apr;15(4). DOI: 10.7759/cureus.37080
Cohen SP, Greuber E, Vought K, Lissin D. Safety of epidural steroid injections for lumbosacral radicular pain: unmet medical need. The Clinical journal of pain. 2021 Sep 1;37(9):707-17. DOI: 10.1097/AJP.0000000000000963
Orrillo E, Neira LV, Piedimonte F, Sanchez RP, Mihovilovic SA, Tamayo MA, Rekatsina M, Varrassi G. What is new in the clinical management of low back pain: a narrative review. Cureus. 2022 Mar;14(3). DOI: 10.7759/cureus.22992
Natera D, Romero KJ, Curcio JC, Montalvo VV, Navarro FM, Imran M, Nishat N, Concepcion JC, Bolous A, Clervil K, Ann K. Interventional Management of Low Back Pain: A Comprehensive Review of Epidural Steroid Injections and Related Techniques. J Anest & Inten Care Med March 2024; 13(3): DOI: 10.19080/JAICM.2024.13.555864
Munir I, Ijaz F, Shoaib U, Yahya F, Aftab RK, Farid M. Prevalence of Digital Eye Strain in the Gaming Community of Pakistan during First Countrywide COVID Lockdown. 18, Issue 01 2022 Jan;18(01):1-5. DOI: https://doi.org/10.51273/esc22.251813
Nguyen C, De Sèze M, Rannou F. The challenges of precision medicine in chronic low back pain: Lessons learned from active discopathy. Annals of physical and rehabilitation medicine. 2021 Mar;64(2):101504-506. https://doi.org/10.1016/j.rehab.2021.101504
Rasi AM, Mirbolook A, Darestani RT, Sayadi S, Ebadi SS. Conservative treatment of low back pain in lumbar disc herniation: comparison of three therapeutic regimens. Systematic Reviews in Pharmacy. 2020 Aug 1;11(8):765-9. DOI:10.31838/srp.2020.8.110
Dr. Vivian D’ Almeida, Dr. Vinayak, Dr. Ashwin Kamath, Dr. Jubin Abraham Raju, Dr. K Raghuveer Adiga. Efficacy of epidural steroid injection in lumbar disc disease. Int J Orthop Sci 2018;4(3):01-05. DOI: 10.22271/ortho.2018.v4.i3a.01
Sabih V, Zahir J, Zulfiqar H, Shah AA, Shahani A, Azeem Y. Postoperative Analgesia after Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2022;18(4):269-73. DOI: https://doi.org/10.48036/apims.v18i4.701
De Bruijn TM, De Groot IB, Miedema HS, Haumann J, Ostelo RW. Clinical relevance of epidural steroid injections on lumbosacral radicular syndrome-related synptoms: systematic review and meta-analysis. The Clinical Journal of Pain. 2021 Jul 1;37(7):524-37. http://dx.doi.org/10.1097/AJP.0000000000000943
De Bruijn TM, De Groot IB, Miedema HS, Haumann J, Ostelo RW. Clinical relevance of epidural steroid injections on lumbosacral radicular syndrome-related synptoms: Systematic review and meta-analysis. The Clinical Journal of Pain. 2021 Jul 1;37(7):524-37. DOI: 10.1097/AJP.0000000000000943
Rhim HC, Ruiz J, Taseh A, Afunugo W, Crockett Z, Schon J, et al . Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis. Journal of Clinical Medicine. 2024 Feb 17;13(4):1132. https://doi.org/10.3390/jcm13041132
Nicol V, Verdaguer C, Daste C, Bisseriex H, Lapeyre É, Lefèvre-Colau MM, Rannou F, Rören A, Facione J, Nguyen C. Chronic low back pain: a narrative review of recent international guidelines for diagnosis and conservative treatment. Journal of clinical medicine. 2023 Feb 20;12(4):1685-90. https://doi.org/10.3390/jcm12041685
Gopalswami AD, Kumar SS, Sinha AG. Gait parameters and functional performance following multi-factorial treatment among degenerative joint disease patients. Biomedicine. 2021 Apr 3;41(1):112-9. DOI: https://doi.org/10.51248/.v41i1.544
Ranganatha Babu Kurupati DV, Sadalagi PS, Lokesh BV, Sujai S. Functional outcome of chronic low back ache due to a prolapsed inter-vertebral disc treated with caudal epidural steroid injection–a prospective study. International Journal of Orthopaedics. 2020;6(3):237-40. https://doi.org/10.33438/ijdshs.1380877
Lilly DT, Davison MA, Eldridge CM, Singh R, Montgomery EY, Bagley C, Adogwa O. An assessment of nonoperative management strategies in a herniated lumbar disc population: successes versus failures. Global spine journal. 2021 Sep;11(7):1054-63. https://doi.org/10.1177/2192568220936217
Pandey KK, Vidyarthi A, Johari V, Dhakar JS. CAUDAL EPIDURAL STEROID INJECTION: A PROSPECTIVE STUDY IN THE PATIENTS WITH LOW BACK PAIN. Int J Acad Med Pharm. 2023;5(3):1637-42. DOI: 10.4103/aihb.aihb_190_24
Rahman UA, Iftikhar MA, Butt MJ, Ahmed K, Ahmed I. Is Tramadol Better Than Bupivicane in Reducing Post Operative Pain after Lichtenstien Mesh Hernioplasty When Administered in Wound; A Comparative Study. Issue 03 2023;19(3) 323-28. DOI: https://doi.org/10.51273/esc23.251319313
Jayaseeli P, Suganthi S, Devendran R. COMPARISON OF FUNCTIONAL OUTCOME AND PAIN RELIEF OF EPIDURAL TRIAMCINOLONE VS CONSERVATIVE MANAGEMENT FOR LUMBAR DISC DISEASE. Int J Acad Med Pharm. 2023;5(5):1014-8. DOI: 10.47009/jamp.2023.5.5.199.
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