Epidural
steroid injections are the most commonly used procedures to manage chronic
low back pain in interventional
pain management settings. The overall effectiveness of epidural
steroid injections has been highly variable, and in the role has not been evaluated in patients discographically evaluated. One hundred consecutive patients, without evidence of
disc herniation or
radiculitis, who had failed to respond to
conservative management with
physical therapy, chiropractic and/or medical
therapy, underwent discography utilizing strict criteria of concordant
pain, and negative adjacent discs, after being judged to be negative for facet joint and/or sacroiliac joint
pain utilizing comparative
local anesthetic blocks. Any other type of response was considered negative. This study included 62 patients, who underwent caudal epidural
steroid injections with
Sarapin. They included Group I, comprised of 45 of 55 patients negative on provocative discography; and Group II, with 17 of 45 patients with positive provocative discography. Results showed that there was significant improvement in patients receiving caudal
epidural injections, with a decrease in
pain associated with improved physical, functional, and mental status; decreased
narcotic intake, and increased return to work. The study showed that at 1 month, 100% of the patients evaluated showed significant improvement in both groups; this declined to 86% at 3 months in Group I, but remained at 100% in Group II, declining to 60% and 64% at 6 months in Group I and Group II, respectfully, with administration of one to three
injections. Analysis with one to three
injections, which included all (62) patients showed significant relief in 71% and 65% of the patients at 1 month, in 67% and 65% at 3 months, and in 47% and 41% at 6 months, in Group I and Group II, respectively. In conclusion, caudal
epidural injections with or without
steroids is an effective modality of treatment in managing chronic, persistent
low back pain failing to respond to conservative modalities of treatments, in patients negative for facet joint and sacroiliac joint
pain, whether positive or negative, on evaluation with provocative discography.