Epidural use of glucocorticosteroids for treating radicular pain: narrative review

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

This review aimed to examine the history of the epidural use of glucocorticosteroids (GCS), perception of the safety of epidural administration of GCS, and examples of clinical use for the treatment of radiculopathies and radicular pain. The search for publications covered the period from February 2, 2023, to September 1, 2023, in PubMed, Medline, Cochrane Library, and the International Association for the Study of Pain. The search identified 306 studies, of which 243 were excluded because they described the pathophysiology and treatment of chronic pain syndromes other than neuropathic pain and epidural use of GCS. The remaining 63 publications were included in the review. The results of the analysis of the materials and publications revealed that the epidural use of GCS showed high effectiveness both as an independent method of treating radicular pain with neuropathy and as part of complex therapy. In some cases, the epidural use of GCS does not exclude neurosurgical intervention.

Full Text

Restricted Access

About the authors

Dmitrii A. Fedorov

Federal Siberian Scientific and Clinical Center; Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: 293333666fedorov@gmail.com
ORCID iD: 0000-0002-1860-4609
SPIN-code: 6912-7740

anesthesiologist-resuscitator

Russian Federation, 26 Kolomenskaya Str., 660037, Krasnoyarsk; Krasnoyarsk

Vladimir V. Khinovker

Federal Siberian Scientific and Clinical Center; Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: vhinov@hotmail.com
ORCID iD: 0000-0002-3162-6298
SPIN-code: 8640-9591

MD, Dr. Sci. (Med.)

Russian Federation, Krasnoyarsk; Krasnoyarsk

Viktor A. Koriachkin

St. Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Ekaterina V. Khinovker

Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: khinov@mail.ru
ORCID iD: 0000-0002-8860-9480
SPIN-code: 7440-1924

anesthesiologist-resuscitator

Russian Federation, Krasnoyarsk

Alexandr V. Kukharev

Federal Siberian Scientific and Clinical Center

Author for correspondence.
Email: kuharevav@mail.ru
ORCID iD: 0000-0001-7709-5800

neurosurgeon

Russian Federation, Krasnoyarsk

References

  1. Epstein NE. Major risks and complications of cervical epidural steroid injections: An updated review. Surg Neurol Int. 2018;(9):86. doi: 10.4103/sni.sni_85_18
  2. Schneider BJ, Maybin S, Sturos E. Safety and Complications of Cervical Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018;29(1):155–169. doi: 10.1016/i.pmr.2017.08.012
  3. Rivera CE. Lumbar Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018;29(1):73–92. doi: 10.1016/i.pmr.2017.08.007
  4. Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg. 2016;122(3):857–870. doi: 10.1213/ANE.0000000000001155
  5. Heliövaara M, Knekt P, Aromaa A. Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization. J Chronic Dis. 1987;40(3):251–258. doi: 10.1016/0021-9681(87)90161-5
  6. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015;372(13):1240–1248. doi: 10.1056/NEJMra1410151
  7. Weber H. The natural history of disc herniation and the influence of intervention. Spine (Phila Pa 1976). 1994;19(19):2234–2238;discussion 2233. doi: 10.1097/00007632-199410000-00022
  8. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33(25):2789–2800. doi: 10.1097/BRS.0b013e31818ed8f4
  9. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284–299. doi: 10.1016/j.mayocp.2014.09.008
  10. Waterman BR, Belmont PJ, Schoenfeld AJ. Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J. 2012;12(1):63–70. doi: 10.1016/j.spinee.2011.09.002
  11. Van Boxem K, Cheng J, Patijn J, et al. 11. Lumbosacral radicular pain. Pain Pract. 2010;10(4):339–358. doi: 10.1111/j.1533-2500.2010.00370.x
  12. Konstantinou K, Hider SL, Jordan JL, et al. The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature. Clin J Pain. 2013;29(7):644–654. doi: 10.1097/AJP.0b013e31826f9a52
  13. McLain RF, Kapural L, Mekhail NA. Epidural steroids for back and leg pain: mechanism of action and efficacy. Cleve Clin J Med. 2004;71(12):961–970. doi: 10.3949/ccjm.71.12.961
  14. Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988;318(5):291–300. doi: 10.1056/NEJM198802043180506
  15. Juniper M, Le TK, Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother. 2009;10(16):2581–2592. doi: 10.1517/14656560903304063
  16. Koryachkin VA, Khinovker VV, Gazenkampf AA, Fedorov DA. Interventional methods of treatment of chronic and acute root pain. Modern problems of science and education. 2019 [cited 2023 Nov 30];(6):1–5. Available from: https://science-education.ru/ru/article/view?id=29242 (In Russ).
  17. Robecchi P, Capra AL. L’idrocortisone (composto F), prime esperienze cliniche in campo reumatologico. Minerva Med. 1952;43(98):1259–1263.
  18. Lièvre JA, Bloch-Michel H, Pean G, et al. Hydrocortisone local injection. Rev Rhum Mal Osteoartic. 1953;(20):310–311. (In French).
  19. Goebert HW Jr, Jallo SJ, Gardner WJ, et al. Sciatica: treatment with epidural injections of procaine and hydrocortisone. Cleve Clin Q. 1960;(27):191–197. doi: 10.3949/ccjm.27.4.191
  20. Nelson DA, Landau WM. Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports. J Neurol Neurosurg Psychiatry. 2001;70(4):433–443. doi: 10.1136/jnnp.70.4.433
  21. Gardner WJ, Goebert HW Jr, Sehgal AD. Intraspinal corticosteroids in the treatment of sciatica. Trans Am Neurol Assoc. 1961;(86):214–215.
  22. Sehgal AD, Gardner WJ, Dohn DF. Pantopaque ‘arachnoiditis’ treatment with subarachnoid injection of corticosteroids. Cleveland Clinic Journal of Medicine. 1962;(29):177–188.
  23. Brown JH. Pressure caudal anesthesia and back manipulation. Conservative method for treatment of sciatica. Northwest Med. 1960;(59):905–909.
  24. Winnie AP, Hartman JT, Meyers HL Jr, et al. Pain clinic. II. Intradural and extradural corticosteroids for sciatica. Anesth Analg. 1972;51(6):990–999.
  25. Rosen CD, Kahanovitz N, Bernstein R, Viola K. A retrospective analysis of the efficacy of epidural steroid injections. Clin Orthop Relat Res. 1988;(228):270–272.
  26. Power RA, Taylor GJ, Fyfe IS. Lumbar epidural injection of steroid in acute prolapsed intervertebral discs. A prospective study. Spine (Phila Pa 1976). 1992;17(4):453–455. doi: 10.1097/00007632-199204000-00015
  27. Bowman SJ, Wedderburn L, Whaley A, et al. Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine (Phila Pa 1976). 1993;18(10):1345–1350. doi: 10.1097/00007632-199308000-00014
  28. Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J. 1973;2(5867):635–637. doi: 10.1136/bmj.2.5867.635
  29. Snoek W, Weber H, Jorgensen B. Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs. Acta Orthop Scand. 1977;48(6):635–641. doi: 10.3109/17453677708994810
  30. Fedorov DA, Khinovker VV, Koriachkin VA. Сomparative effectiveness of various methods of epidural administration of glucocorticosteroids in treating root pain syndromes. Regional Anesthesia and Acute Pain Management. 2022;16(1):59–70. (In Russ). doi: 10.17816/RA108077
  31. Patel K, Chopra P, Upadhyayula S. Epidural Steroid Injections. Treasure Island (FL): StatPearls Publishing; 2023.
  32. Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):865–877. doi: 10.7326/0003-4819-157-12-201212180-00564
  33. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490
  34. Botwin KP, Gruber RD, Bouchlas CG, et al. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000;81(8):1045–1050. doi: 10.1053/apmr.2000.7166
  35. Epstein NE. The risks of epidural and transforaminal steroid injections in the Spine: commentary and a comprehensive review of the literature. Surg Neurol Int. 2013;4(Suppl 2):S74–S93. doi: 10.4103/2152-7806.109446
  36. El-Yahchouchi CA, Plastaras CT, Maus TP, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: a multi-institutional study. Pain Med. 2016;17(2):239–249. doi: 10.1111/pme.12896
  37. Plastaras C, McCormick ZL, Garvan C, et al. Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J. 2015;15(10):2157–2165. doi: 10.1016/j.spinee.2015.05.034
  38. Abram SE, O’Connor TC. Complications associated with epidural steroid injections. Reg Anaesth. 1996;21(2):149–162.
  39. Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med. 2009;10(8):1389–1394. doi: 10.1111/j.1526-4637.2009.00728.x
  40. Somayaji HS, Saifuddin A, Casey AT, Briggs TW. Spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection. Spine (Phila Pa 1976). 2005;30(4):E106–E108. doi: 10.1097/01.brs.0000153400.67526.07
  41. Deshpande DM, Krishnan C, Kerr DA. Transverse myelitis after lumbar steroid injection in a patient with Behcet’s disease. Spinal Cord. 2005;43(12):735–737. doi: 10.1038/sj.sc.3101779
  42. Lyders EM, Morris PP. A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol. 2009;30(9):1691–1693. doi: 10.3174/ajnr.A1567
  43. Malani AN, Vandenberg DM, Singal B, et al. Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate. JAMA. 2013;309(23):2465–2472. doi: 10.1001/jama.2013.6293
  44. Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122(5):974–984. doi: 10.1097/ALN.0000000000000614
  45. Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA. 2015;313(17):1713–1714. doi: 10.1001/jama.2015.2912
  46. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain [Internet]. FDA. U.S. Food & Drug Administration; 2016 [cited 2023 Nov 30]. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm394280.htm
  47. Manchikanti L, Candido KD, Singh V, et al. Epidural steroid warning controversy still dogging FDA. Pain Physician. 2014;17(4):E451–E474.
  48. Candido KD, Knezevic NN, Chang-Chien GC, Deer TR. The Food and Drug Administration’s recent action on April 23, 2014 failed to appropriately address safety concerns about epidural steroid use. Pain Physician. 2014;17(4):E549–E552.
  49. Peng B, Wu W, Li Z, et al. Chemical radiculitis. Pain. 2007;127(1–2):11–16. doi: 10.1016/j.pain.2006.06.034
  50. Takebayashi T, Cavanaugh JM, Ozaktay A, et al. Effect of nucleus pulposus on the activity of dorsal root ganglion. Spine (Phila Pa 1976). 2001;26(8):940–945. doi: 10.1097/00007632-200104150-00018
  51. Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain. 1977;3(1):25–41. doi: 10. 1016/0304-3959(77)90033-1
  52. Murphy RW. Nerve roots and spinal nerves in degenerative disc disease. Clin Orthop Relat Res. 1977;(129):46–60. doi: 10.1097/00003086-197711000-00005
  53. Manchikanti L, Singh V. Interventional Techniques in Chronic Spinal Pain. Chapter 23: Lumbar Interlaminar Epidural Steroid Injections. Paducah: KY, ASIPP Publishing; 2007.
  54. Badokin VV. Locomotor therapy with extended-release crystalline glucocorticoids. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(2):88–92. (In Russ). doi: 10.14412/2074-2711-2013-2420
  55. Barinov AN, Mozolevsky YuV. Combination treatment for tunnel neuropathies of the lower extremities. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(4):10–20. (In Russ). doi: 10.14412/2074-2711-2013-2449
  56. Xie W, Luo S, Xuan H, et al. Betamethasone affects cerebral expressions of NF-kappaB and cytokines that correlate with pain behavior in a ratmodel of neuropathy. Ann Clin Lab Sci. 2006;36(1):39–46.
  57. Manchikanti L, Buenaventura RM, Manchikanti KN, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199–E245.
  58. Manchikanti L, Knezevic NN, Boswell MV, et al. Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis. Pain Physician. 2016;19(3):E365–E410.
  59. Kennedy DJ, Zheng PZ, Smuck M, et al. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. Spine J. 2018;18(1):29–35. doi: 10.1016/j.spinee.2017.08.264
  60. Singh JR, Cardozo E, Christolias GC. The Clinical Efficacy for Two-Level Transforaminal Epidural Steroid Injections. PM R. 2017;9(4):377–382. doi: 10.1016/j.pmrj.2016.08.030
  61. Budrovac D, Radoš I, Hnatešen D, et al. Effectiveness of Epidural Steroid Injection Depending on Discoradicular Contact: A Prospective Randomized Trial. Int J Environ Res Public Health. 2023;20(4):3672. doi: 10.3390/ijerph20043672
  62. Güven A, Akkemik Ü, Özgencil GE. Comparison of efficacy of particulate and non-particulate steroids in patients with lumbosacral pain, non-operated patients with chronic radicular symptoms. Agri. 2023;35(2):68–75. doi: 10.14744/agri.2022.02779
  63. Mehta P, Syrop I, Singh JR, Kirschner J. Systematic Review of the Efficacy of Particulate Versus Nonparticulate Corticosteroids in Epidural Injections. PM R. 2017;9(5):502–512. doi: 10.1016/j.pmrj.2016.11.008

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2023 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies