Regresar

Evaluation of analgesia obtained with steroids epidurals in the treatment of chronic low back pain

Abstract:

Introduction: In México the reports about the incidence of chronic low back pain are scarce however it has been proposes that 24.2 million of Mexicans have a chronic painful condition. It has been documented that low back pain is the most frequent cause of chronic pain. For the treatment of low back pain a wide variety of treatments had been described, these include pharmacological approaches, physiotherapy, and surgical and non-surgical interventions. Form the non-surgical interventions an epidural injection with steroids has been considered a good alternative, this is because it is believed that this approach will promote an increase in the functionality of the patient and will decrease opiate consumption in the short term. Material and methods: A search of published literature was made using electronic databases such as PUBMED, and EMBASE; and locating documents that in the title presented the word «low back pain» and «steroid», «betametasone», «prednisolone», «methylprednisolone», «triamcinolone», «methylprednisone», «triamcinolone», «hydrocortisone» and «dexametasone». Results: Steroid use was evaluated in diverse painful alterations such as discal hernia, radiculitis, spinal stenosis, and post laminectmy syndrome. With the interlaminar approach an improvement in pain intensity and the function was observed in those whom were treated with triamcinolone either with fluoroscopy or without it. Methylprednisolone administered by epidural injection using an interlaminar approach did not showed differences in the intensity of pain. With an epidural injection of betametasone using a transforminal approach a decrease in the intensity of pain and an improvement of the function was observed although this result was controversial. The caudal epidural approach showed a reduction of at least 50% in the intensity of pain that lasted for 30 weeks, and an increase of the functionality was documented; those results were obtained after the administration of triamcinolone and betametasone.