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If you’re going to administer epidural corticosteroid injections for lower back pain, it’s much better to give them sooner rather than later. That’s the conclusion of a study by William Ackerman, MD, and Mahmood Ahmad, MD, of Integrative Pain Medicine of Arkansas in Little Rock.
They say epidural corticosteroid injections administered four weeks or more after onset of lower back pain give less and shorter-lasting relief than when given earlier.
The doctors presented the findings at the recent American Society of Anesthesiologists annual meeting. They retrospectively studied 80 patients who had received epidural injections of triamcinolone within 16 weeks of the onset of radicular pain associated with L5 to S1 disc herniation. All patients had herniation confirmed by magnetic resonance imaging and failed conservative therapy.
After the injections, nurses asked the patients to score their pain relief on a scale of one to 10 and to estimate how long it lasted. Relief was defined as a greater than 75% improvement in the analogue score after the injection.
Seventeen of 20 patients (85%) who had injections within four weeks of pain onset reported relief that lasted up to 92 days. That was significantly better than the other three groups of patients who had later injections, Ahmad says.
About 60% of those who received injections within five to eight weeks had relief lasting 51 days. Sixty percent of the third group — those who received injections within nine to 12 weeks — reported relief, but it only lasted 18 days. Only 10 of 20 patients who received injections 13 to 16 weeks after pain onset had relief, and it lasted only nine days.