The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Epidural Steroid Injection in Korean Pain Physicians: A National Survey

  • Kim, Eun Jung (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Moon, Jee Youn (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Park, Keun Suk (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Yoo, Da Hye (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Kim, Yong Chul (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Sim, Woo Seog (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Chul Joong (Department of Anesthesiology and Pain Medicine, Zein Pain Treatment Clinic) ;
  • Shin, Hwa Yong (Department of Anesthesiology & Pain Medicine, Chung Ang University Hospital) ;
  • Kim, Jae Hun (Department of Anesthesiology & Pain Medicine, Konkuk University Medical Center) ;
  • Kim, Yeon Dong (Department of Anesthesiology & Pain Medicine, Wonkwang University School of Medicine) ;
  • Lee, Se Jin (Department of Anesthesiology & Pain Medicine, Soonchunhyang University Seoul Hospital)
  • Received : 2013.11.06
  • Accepted : 2013.12.10
  • Published : 2014.01.01
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Abstract

Background: Epidural steroid injection (ESI) is one of the most common procedures for patients presenting low back pain and radiculopathy. However, there is no clear consensus on what constitutes appropriate steroid use for ESIs. To investigate optimal steroid injection methods for ESIs, surveys were sent to all academic pain centers and selected private practices in Korea via e-mail. Methods: Among 173 pain centers which requested the public health insurance reimbursements for their ESIs and were enrolled in the Korean Pain Society, 122 completed questionnaires were returned, for a rate of 70.5%; also returned were surveys from 39 academic programs and 85 private practices with response rates of 83.0% and 65.9%, respectively. Results: More than half (55%) of Korean pain physicians used dexamethasone for ESIs. The minimum interval of subsequent ESIs at the academic institutions (3.1 weeks) and the private practices (2.1 weeks) were statistically different (P = 0.01). Conclusions: Although there was a wide range of variation, there were no significant differences between the academic institutions and the private practices in terms of the types and single doses of steroids for ESIs, the annual dose of steroids, or the limitations of doses in the event of diabetes, with the exception of the minimum interval before the subsequent ESI.

Keywords

References

  1. Cho NH, Jung YO, Lim SH, Chung CK, Kim HA. The prevalence and risk factors of low back pain in rural community residents of Korea. Spine (Phila Pa 1976) 2012;37: 2001-10. https://doi.org/10.1097/BRS.0b013e31825d1fa8
  2. Baek SR, Lim JY, Lim JY, Park JH, Lee JJ, Lee SB, et al. Prevalence of musculoskeletal pain in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr 2010;51: e46-51. https://doi.org/10.1016/j.archger.2009.11.011
  3. Son KM, Cho NH, Lim SH, Kim HA. Prevalence and risk factor of neck pain in elderly Korean community residents. J Korean Med Sci 2013; 28: 680-6. https://doi.org/10.3346/jkms.2013.28.5.680
  4. Koh MJ, Park SY, Woo YS, Kang SH, Park SH, Chun HJ, et al. Assessing the prevalence of recurrent neck and shoulder pain in Korean high school male students: a cross-sectional observational study. Korean J Pain 2012;25: 161-7. https://doi.org/10.3344/kjp.2012.25.3.161
  5. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171. https://doi.org/10.1136/bmj.a171
  6. El Sissi W, Arnaout A, Chaarani MW, Fouad M, El Assuity W, Zalzala M, et al. Prevalence of neuropathic pain among patients with chronic low-back pain in the Arabian Gulf Region assessed using the leeds assessment of neuropathic symptoms and signs pain scale. J Int Med Res 2010; 38:2135-45. https://doi.org/10.1177/147323001003800629
  7. Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med 2005; 30: 422-8.
  8. Beith ID, Kemp A, Kenyon J, Prout M, Chestnut TJ. Identifying neuropathic back and leg pain: a cross-sectional study. Pain 2011; 152: 1511-6. https://doi.org/10.1016/j.pain.2011.02.033
  9. Lievre JA, Bloch-Michel H, Pean G, Uro J. L'hydrocortisone en injection locale. Rev Rhum Mal Osteoartic 1953; 20:310-1.
  10. Manchikanti L, Pampati V, Falco FJ, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine (Phila Pa 1976) 2013; 38: 157-68. https://doi.org/10.1097/BRS.0b013e318267f463
  11. Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain 1986; 24: 277-95. https://doi.org/10.1016/0304-3959(86)90115-6
  12. Wilkinson IM, Cohen SP. Epidural steroid injections. Curr Pain Headache Rep 2012; 16: 50-9. https://doi.org/10.1007/s11916-011-0236-9
  13. Wilkinson I, Cohen SP. Epidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review. Curr Opin Anaesthesiol 2013 [in press].
  14. Devor M, Govrin-Lippmann R, Raber P. Corticosteroids suppress ectopic neural discharge originating in experimental neuromas. Pain 1985; 22: 127-37. https://doi.org/10.1016/0304-3959(85)90173-3
  15. Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 1990; 34: 335-8. https://doi.org/10.1111/j.1399-6576.1990.tb03097.x
  16. Diwan S, Manchikanti L, Benyamin RM, Bryce DA, Geffert S, Hameed H, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician 2012; 15: E405-34.
  17. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 2007; 99: 461-73. https://doi.org/10.1093/bja/aem238
  18. Parr AT, Manchikanti L, Hameed H, Conn A, Manchikanti KN, Benyamin RM, et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician 2012; 15: E159-98.
  19. Quraishi NA. Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis. Eur Spine J 2012; 21: 214-9. https://doi.org/10.1007/s00586-011-2008-y
  20. Jacobs S, Pullan PT, Potter JM, Shenfield GM. Adrenal suppression following extradural steroids. Anaesthesia 1983;38: 953-6. https://doi.org/10.1111/j.1365-2044.1983.tb12025.x
  21. Munck A. Glucocorticoid inhibition of glucose uptake by peripheral tissues: old and new evidence, molecular mechanisms, and physiological significance. Perspect Biol Med 1971; 14: 265-9. https://doi.org/10.1353/pbm.1971.0002
  22. Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J 2004; 4: 468-74. https://doi.org/10.1016/j.spinee.2003.10.007
  23. Glaser SE, Falco F. Paraplegia following a thoracolumbar transforaminal epidural steroid injection. Pain Physician 2005;8: 309-14.
  24. Lestner JM, Smith PB, Cohen-Wolkowiez M, Benjamin DK Jr,Hope WW. Antifungal agents and therapy for infants and children with invasive fungal infections: a pharmacological perspective. Br J Clin Pharmacol 2013; 75: 1381-95. https://doi.org/10.1111/bcp.12025
  25. Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila Pa 1976) 2012;37: E46-50. https://doi.org/10.1097/BRS.0b013e31821fd21f
  26. Cluff R, Mehio AK, Cohen SP, Chang Y, Sang CN, Stojanovic MP. The technical aspects of epidural steroid injections: a national survey. Anesth Analg 2002; 95: 403-8.
  27. Hirata F, Schiffmann E, Venkatasubramanian K, Salomon D, Axelrod J. A phospholipase A2 inhibitory protein in rabbit neutrophils induced by glucocorticoids. Proc Natl Acad Sci U S A 1980; 77: 2533-6. https://doi.org/10.1073/pnas.77.5.2533
  28. Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med 2013; 38: 175-200. https://doi.org/10.1097/AAP.0b013e31828ea086
  29. Kim D, Brown J. Efficacy and safety of lumbar epidural dexamethasone versus methylprednisolone in the treatment of lumbar radiculopathy: a comparison of soluble versus particulate steroids. Clin J Pain 2011; 27: 518-22. https://doi.org/10.1097/AJP.0b013e31820c53e0
  30. Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med 2006; 7: 237-42. https://doi.org/10.1111/j.1526-4637.2006.00162.x
  31. Park CH, Lee SH, Kim BI. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med 2010; 11: 1654-8. https://doi.org/10.1111/j.1526-4637.2010.00941.x
  32. El-Yahchouchi C, Geske JR, Carter RE, Diehn FE, Wald JT, Murthy NS, et al. The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections. Pain Med 2013; 14: 1650-7. https://doi.org/10.1111/pme.12214
  33. Meikle AW, Tyler FH. Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med 1977; 63; 200-7. https://doi.org/10.1016/0002-9343(77)90233-9
  34. Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine (Phila Pa 1976) 1998; 23: 2538-44. https://doi.org/10.1097/00007632-199812010-00008
  35. Bicket MC, Gupta A, Brown CH 4th, Cohen SP. Epidural injections for spinal pain: a systematic review and metaanalysis evaluating the "control" injections in randomized controlled trials. Anesthesiology 2013; 119: 907-31. https://doi.org/10.1097/ALN.0b013e31829c2ddd
  36. Manchikanti L, Boswell MV, Singh V, Benyamin RM, Fellows B, Abdi S, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 2009; 12: 699-802.
  37. Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician 2002; 5: 182-99.
  38. McLain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy. Spine J 2005; 5: 191-201. https://doi.org/10.1016/j.spinee.2004.10.046
  39. Bellini M, Barbieri M. Systemic effects of epidural steroid injections. Anaesthesiol Intensive Ther 2013; 45: 93-8. https://doi.org/10.5603/AIT.2013.0021

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