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Epidural steroid injections for low back pain in rural practice: a 5-year retrospective study.

https://arctichealth.org/en/permalink/ahliterature120314
Source
Can J Rural Med. 2012;17(4):127-34
Publication Type
Article
Date
2012
Author
Azad Mashari
Robert Minty
Lauren Minty
Wilma M Hopman
Len Kelly
Author Affiliation
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Source
Can J Rural Med. 2012;17(4):127-34
Date
2012
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - therapeutic use
Adult
Aged
Female
Humans
Injections, Epidural - methods
Intervertebral Disc Degeneration - drug therapy
Intervertebral Disc Displacement - drug therapy
Low Back Pain - drug therapy
Lumbar Vertebrae
Male
Middle Aged
Ontario
Patient Selection
Retrospective Studies
Rural Population
Spinal Stenosis - drug therapy
Treatment Outcome
Abstract
Epidural steroid injections (ESIs) are a safe and accessible therapy for chronic low back pain, one of the most common and challenging chronic conditions seen in primary care. However, the indications for and effectiveness of ESI remain controversial. In rural settings with limited public transportation infrastructure, such a mobility-limiting condition can have even more negative effects on quality of life and function. Furthermore, diagnostic and specialist services are often limited. A paucity of safe, effective and accessible treatments leads to heavy reliance on oral analgesics, especially opioids, which have well-known complications.
We reviewed the use of ESI for the 2 most common types of chronic low back pain in those with neurologic symptoms: lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). We did a retrospective chart review of all patients who underwent ESI between Jan. 1, 2005, and Feb. 25, 2010, at our rural hospital in northwestern Ontario.
During the study period, 123 ESIs were administered to 65 patients. After the first injection, 40 patients (62%) reported improvement, 10 (15%) reported worsening or no change, and 15 (23%) had no follow-up documented.
Some patients with neurologic compromise from LDH or LSS have improvement in symptoms after ESI. A prospective study is underway to more rigorously assess the effectiveness of this treatment.
PubMed ID
23017344 View in PubMed
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