Epidural injections can reduce pain from spinal stenosis but fact is, very little of the effect is from the steroid. It can reduce pain from 6.6-6.7 to lower 4’s in 3 and 6 weeks – this is a drop of 2 – you will often not see any better from painkillers nor cymbalta. Yet because local can receive results, it is assumed blocks do nothing at all. How stupid is that?
A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis
J.L. Friedly et al
NEJM July 3, 2014 Vol. 371 No. 1; p11-21
http://www.medicinno.com/wp-content/uploads/2014/07/A-Randomized-Trial-of-Epidural-Glucocorticoid.doc
- Steroid and approaches varied re varied geographic site locations
Results:
- Dropped the pain from 7 to a pain level near to four. People could live with (<4 you can ignore some) – It’s not bad.
- They had the audacity to say the shots didn’t work and this decision has been re-quoted by various unthinking journals
Comment – I do something called sweet caudals – I inject nothing but D5W and in some cases, B12 with it. One article noted the following drops of pain with each shot in chronic back pain:
This suggests that any injection relieves pain so obviously the lidocaine did help.
Take home message – use steroid epidural/caudal in spinal stenosis but keep steroid use to 40 mg first time and maybe not at all for 6-12 weeks. Lidocaine or sweet caudals can be given as often as you like in between though I do not use lidocaine in the office..
Hence even sugar water has analgesic effects that are lasting. Why not local as well in spinal stenosis? It seems likely the local has beneficial effects that are being ignored because the local was supposed to be the placebo.
Another issue is “Didn’t anyone turn out the lights? – after some of the spinal pain is gone there will be knots in quadratus lumborum, thoacolumbar, gluteal and piriformis that need attention to but are ignored. Poor marks here people.
For heaven sakes, get your epidural but ask your injector to cut down steroid to 40 mg triamcinolone as its effects seem small With the new advisory to avoid particulate cortisone, just using local looks more tempting.