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Laxmaiah Manchikanti - One of the best experts on this subject based on the ideXlab platform.

  • epidural interventions in the management of chronic spinal Pain american society of interventional Pain physicians asipp comprehensive evidence based guidelines
    Pain Physician, 2021
    Co-Authors: Laxmaiah Manchikanti, Annu Navani, Nebojsa Nick Knezevic, Paul J Christo, Gerard Limerick, Aaron K Calodney, Jay S Grider, Michael E Harned, Lynn Cintron, Christopher Gharibo
    Abstract:

    Background Chronic spinal Pain is the most prevalent chronic disease with employment of multiple modes of interventional techniques including epidural interventions. Multiple randomized controlled trials (RCTs), observational studies, systematic reviews, and guidelines have been published. The recent review of the utilization patterns and expenditures show that there has been a decline in utilization of epidural injections with decrease in inflation adjusted costs from 2009 to 2018. The American Society of Interventional Pain Physicians (ASIPP) published guidelines for interventional techniques in 2013, and guidelines for facet joint interventions in 2020. Consequently, these guidelines have been prepared to update previously existing guidelines. Objective To provide evidence-based guidance in performing therapeutic epidural procedures, including caudal, interlaminar in lumbar, cervical, and thoracic spinal regions, transforaminal in lumbar spine, and percutaneous adhesiolysis in the lumbar spine. Methods The methodology utilized included the development of objective and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of epidural interventions was viewed with best evidence synthesis of available literature and recommendations were provided. Results In preparation of the guidelines, extensive literature review was performed. In addition to review of multiple manuscripts in reference to utilization, expenditures, anatomical and pathophysiological considerations, pharmacological and harmful effects of drugs and procedures, for evidence synthesis we have included 47 systematic reviews and 43 RCTs covering all epidural interventions to meet the objectives.The evidence recommendations are as follows: Disc herniation: Based on relevant, high-quality fluoroscopically guided epidural injections, with or without steroids, and results of previous systematic reviews, the evidence is Level I for caudal epidural injections, lumbar interlaminar epidural injections, lumbar transforaminal epidural injections, and cervical interlaminar epidural injections with strong recommendation for long-term effectiveness.The evidence for percutaneous adhesiolysis in managing disc herniation based on one high-quality, placebo-controlled RCT is Level II with moderate to strong recommendation for long-term improvement in patients nonresponsive to conservative management and fluoroscopically guided epidural injections. For thoracic disc herniation, based on one relevant, high-quality RCT of thoracic epidural with fluoroscopic guidance, with or without steroids, the evidence is Level II with moderate to strong recommendation for long-term effectiveness.Spinal stenosis: The evidence based on one high-quality RCT in each category the evidence is Level III to II for fluoroscopically guided caudal epidural injections with moderate to strong recommendation and Level II for fluoroscopically guided lumbar and cervical interlaminar epidural injections with moderate to strong recommendation for long-term effectiveness.The evidence for lumbar transforaminal epidural injections is Level IV to III with moderate recommendation with fluoroscopically guided lumbar transforaminal epidural injections for long-term improvement. The evidence for percutaneous adhesiolysis in lumbar stenosis based on relevant, moderate to high quality RCTs, observational studies, and systematic reviews is Level II with moderate to strong recommendation for long-term improvement after failure of conservative management and fluoroscopically guided epidural injections. Axial Discogenic Pain: The evidence for axial Discogenic Pain without facet joint Pain or sacroiliac joint Pain in the lumbar and cervical spine with fluoroscopically guided caudal, lumbar and cervical interlaminar epidural injections, based on one relevant high quality RCT in each category is Level II with moderate to strong recommendation for long-term improvement, with or without steroids. Post-surgery syndrome: The evidence for lumbar and cervical post-surgery syndrome based on one relevant, high-quality RCT with fluoroscopic guidance for caudal and cervical interlaminar epidural injections, with or without steroids, is Level II with moderate to strong recommendation for long-term improvement. For percutaneous adhesiolysis, based on multiple moderate to high-quality RCTs and systematic reviews, the evidence is Level I with strong recommendation for long-term improvement after failure of conservative management and fluoroscopically guided epidural injections. Limitations The limitations of these guidelines include a continued paucity of high-quality studies for some techniques and various conditions including spinal stenosis, post-surgery syndrome, and Discogenic Pain. Conclusions These epidural intervention guidelines including percutaneous adhesiolysis were prepared with a comprehensive review of the literature with methodologic quality assessment and determination of level of evidence with strength of recommendations.

  • lack of superiority of epidural injections with lidocaine with steroids compared to without steroids in spinal Pain a systematic review and meta analysis
    Pain Physician, 2020
    Co-Authors: Nebojsa Nick Knezevic, Laxmaiah Manchikanti, Mahendra R Sanapati, Ivan Urits, Vwaire Orhurhu, Brahma Prasad Vangala, Rachana Vanaparthy, Shalini Shah, Amol Soin, Amit Mahajan
    Abstract:

    Background Multiple randomized controlled trials (RCTs) and systematic reviews have been conducted to summarize the evidence for administration of local anesthetic (lidocaine) alone or with steroids, with discordant opinions, more in favor of equal effect with local anesthetic alone or with steroids. Objective To evaluate the comparative effectiveness of lidocaine alone and lidocaine with steroids in managing spinal Pain to assess superiority or equivalency. Study design A systematic review of RCTs assessing the effectiveness of lidocaine alone compared with addition of steroids to lidocaine in managing spinal Pain secondary to multiple causes (disc herniation, radiculitis, Discogenic Pain, spinal stenosis, and post-surgery syndrome). Methods This systematic review was performed utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) for literature search, Cochrane review criteria, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) to assess the methodologic quality assessment and qualitative analysis utilizing best evidence synthesis principles, and quantitative analysis utilizing conventional and single-arm meta-analysis. PubMed, Cochrane Library, US National Guideline Clearinghouse, Google Scholar, and prior systematic reviews and reference lists were utilized in the literature search from 1966 through December 2019. The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. Outcome measures A hard endpoint for the primary outcome was defined as the proportion of patients with 50% Pain relief and improvement in function. Secondary outcome measures, or soft endpoints, were Pain relief and/or improvement in function. Effectiveness was determined as short-term if it was less than 6 months. Improvement that lasted longer than 6 months, was defined as long-term. Results Based on search criteria, 15 manuscripts were identified and considered for inclusion for qualitative analysis, quantitative analysis with conventional meta-analysis, and single-arm meta-analysis. The results showed Level II, moderate evidence, for short-term and long-term improvement in Pain and function with the application of epidural injections with local anesthetic with or without steroid in managing spinal Pain of multiple origins. Limitations Despite 15 RCTs, evidence may still be considered as less than optimal and further studies are recommended. Conclusion Overall, the present meta-analysis shows moderate (Level II) evidence for epidural injections with lidocaine with or without steroids in managing spinal Pain secondary to disc herniation, spinal stenosis, Discogenic Pain, and post-surgery syndrome based on relevant, high-quality RCTs. Results were similar for lidocaine, with or without steroids.

  • cervical interlaminar epidural injections in the treatment of cervical disc herniation post surgery syndrome or Discogenic Pain cost utility analysis from randomized trials
    Pain Physician, 2019
    Co-Authors: Laxmaiah Manchikanti, Allan T Parr, Vidyasagar Pampati, Maanasa V Manchikanti, Mahendra R Sanapati, Alan D Kaye, Joshua A Hirsch
    Abstract:

    Background Neck Pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck Pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck Pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). Objectives To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity Pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or Discogenic neck Pain. Study design Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or Discogenic Pain. Setting A contemporary, private, specialty referral interventional Pain management center in the United States. Methods Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical Discogenic or axial neck back Pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in Pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, Discogenic Pain, and cervical post-surgery syndrome. Results The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or Discogenic Pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. Limitations The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. Conclusion This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or Discogenic neck Pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. Key words Cervical interlaminar epidural injections, chronic neck Pain, cervical disc herniation, cervical Discogenic Pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years.

  • cost utility analysis of lumbar interlaminar epidural injections in the treatment of lumbar disc herniation central spinal stenosis and axial or Discogenic low back Pain
    Pain Physician, 2017
    Co-Authors: Laxmaiah Manchikanti, Ramsin M Benyamin, Joshua A Hirsch
    Abstract:

    BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional Pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity Pain secondary to lumbar disc herniation, spinal stenosis, and axial or Discogenic low back Pain. STUDY DESIGN: Analysis based on 3 previously published randomized trials of effectiveness of lumbar interlaminar epidural injections assessing their role in disc herniation, spinal stenosis, and axial or Discogenic Pain. SETTING: A contemporary, private, specialty referral interventional Pain management center in the United States. METHODS: Cost utility of lumbar interlaminar epidural injections with or without steroids in managing lumbar disc herniation, central spinal stenosis, and Discogenic or axial low back Pain was conducted with data derived from 3 RCTs that included a 2-year follow-up, with inclusion of 360 patients. The primary outcome was significant improvement defined as at least a 50% in Pain reduction and disability status. Direct payment data from 2016 was utilized for assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.6 to accommodate for indirect payments respectively for disc herniation, spinal stenosis, Discogenic Pain. RESULTS: The results of 3 RCTs showed direct cost utility for one year of quality-adjusted life year (QALY) of $2,050.87 for disc herniation, $2,112.25 for axial or Discogenic Pain without disc herniation, and $1,773.28 for spinal stenosis, with an average cost per one year QALY of $1,976.58, with total estimated costs of $3,425, $3,527, $2,961, and $3,301 respectively. LIMITATIONS: The limitation of this cost utility analysis includes that it is a single center evaluation, even though 360 patients were included in this analysis. Further, only the costs of interventional procedures and physician visits were assessed based on the data, with extrapolation of indirect costs presenting the overall total costs. The benefits of returning to work were not assessed. CONCLUSION: This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or Discogenic low back Pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.

  • an update on the management of chronic lumbar Discogenic Pain
    Pain management, 2015
    Co-Authors: Laxmaiah Manchikanti, Joshua A Hirsch
    Abstract:

    Lumbar degenerative disc disease without disc herniation, also known as Discogenic Pain, is an elusive diagnosis of chronic low back Pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar Discogenic Pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar Discogenic Pain. This review provides an updated assessment of the management of chronic lumbar Discogenic Pain with a critical look at the many modalities of treatments that are currently available.

Ramsin M Benyamin - One of the best experts on this subject based on the ideXlab platform.

  • cost utility analysis of lumbar interlaminar epidural injections in the treatment of lumbar disc herniation central spinal stenosis and axial or Discogenic low back Pain
    Pain Physician, 2017
    Co-Authors: Laxmaiah Manchikanti, Ramsin M Benyamin, Joshua A Hirsch
    Abstract:

    BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional Pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity Pain secondary to lumbar disc herniation, spinal stenosis, and axial or Discogenic low back Pain. STUDY DESIGN: Analysis based on 3 previously published randomized trials of effectiveness of lumbar interlaminar epidural injections assessing their role in disc herniation, spinal stenosis, and axial or Discogenic Pain. SETTING: A contemporary, private, specialty referral interventional Pain management center in the United States. METHODS: Cost utility of lumbar interlaminar epidural injections with or without steroids in managing lumbar disc herniation, central spinal stenosis, and Discogenic or axial low back Pain was conducted with data derived from 3 RCTs that included a 2-year follow-up, with inclusion of 360 patients. The primary outcome was significant improvement defined as at least a 50% in Pain reduction and disability status. Direct payment data from 2016 was utilized for assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.6 to accommodate for indirect payments respectively for disc herniation, spinal stenosis, Discogenic Pain. RESULTS: The results of 3 RCTs showed direct cost utility for one year of quality-adjusted life year (QALY) of $2,050.87 for disc herniation, $2,112.25 for axial or Discogenic Pain without disc herniation, and $1,773.28 for spinal stenosis, with an average cost per one year QALY of $1,976.58, with total estimated costs of $3,425, $3,527, $2,961, and $3,301 respectively. LIMITATIONS: The limitation of this cost utility analysis includes that it is a single center evaluation, even though 360 patients were included in this analysis. Further, only the costs of interventional procedures and physician visits were assessed based on the data, with extrapolation of indirect costs presenting the overall total costs. The benefits of returning to work were not assessed. CONCLUSION: This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or Discogenic low back Pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.

  • analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial Discogenic Pain local anesthetic alone vs local combined with steroids
    International Journal of Medical Sciences, 2015
    Co-Authors: Laxmaiah Manchikanti, Ramsin M Benyamin, Vidyasagar Pampati, Mark V. Boswell
    Abstract:

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar Discogenic Pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or Discogenic low back Pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or Discogenic Pain, which is Pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar Pain of presumed Discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back Pain not caused by disc herniation, radiculitis, or facet joint Pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as Pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients with axial or Discogenic Pain in the lumbar spine after excluding facet joint and SI Joint Pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back Pain with a potential superiority for a lumbar interlaminar approach over a caudal approach.

  • a randomized double blind active controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or Discogenic low back Pain results of 2 year follow up
    Pain Physician, 2013
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Carla D Mcmanus, Ramsin M Benyamin
    Abstract:

    BACKGROUND Chronic low back with or without lower extremity Pain is extremely common, expensive, and disabling. However, all modalities of treatments are directed towards disc herniation which is responsible for a very small proportion of the patients. Thus, chronic low back Pain without disc herniation is common. Multiple modalities of treatments are utilized in managing axial or Discogenic Pain including surgery and epidural injections including surgery, intradiscal therapies, and epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of all modalities treatments in managing axial or Discogenic Pain in the lumbar spine. STUDY DESIGN A randomized, double-blind, active control trial. SETTING A private practice, specialty referral, interventional Pain management practice in the United States. OBJECTIVES To evaluate the ability to assess the effectiveness of lumbar interlaminar epidural injections in managing chronic axial or Discogenic low back Pain with epidural injections of local anesthetic with or without steroids. METHODS In this study, a total of 120 patients were randomly allocated to one of the 2 groups receiving either local anesthetic alone or local anesthetic with steroids with 60 patients in each group. The primary outcome measure was at least 50% improvement in the numeric rating scale (NRS) and Oswestry Disability Index (ODI). Outcomes were assessed at 3, 6, 12, 18, and 24 months post treatment. RESULTS Significant Pain relief and functional status improvement defined as at least 50% or more reduction in scores from baseline were observed in 72% of patients receiving local anesthetic alone and 67% of the patients receiving local anesthetic with steroids. Opioid intake was reduced from baseline in each group for 2 years. LIMITATIONS The results of the study are limited by the lack of a placebo group. CONCLUSION Lumbar interlaminar epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back Pain of Discogenic origin without facet joint Pain, disc herniation, and/or radiculitis. TRIAL REGISTRATION NCT00681447.

  • fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or Discogenic Pain
    Journal of Pain Research, 2012
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Vidyasagar Pampati, Carla D Mcmanus, Ramsin M Benyamin
    Abstract:

    Among the multiple causes of chronic low back Pain, axial and Discogenic Pain are common. Various modalities of treatments are utilized in managing Discogenic and axial low back Pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or Discogenic Pain, including epidural injections. In an interventional Pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back Pain of Discogenic origin. However, disc herniation, radiculitis, facet joint Pain, or sacroiliac joint Pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the Pain relief-assessed by numeric rating scale of Pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in Pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back Pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or Discogenic Pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the Pain source.

  • caudal epidural injections in the management of chronic low back Pain a systematic appraisal of the literature
    Pain Physician, 2012
    Co-Authors: Allan T Parr, Laxmaiah Manchikanti, Ramsin M Benyamin, Ann Conn, Sudhir Diwan, Haroon Hameed, Kavita N Manchikanti, Vijay Singh, Salahadin Abdi
    Abstract:

    Background Epidural injections with local anesthetics and steroids are one of the most commonly used interventions in managing chronic low back Pain and lower extremity Pain of various causes. However, despite their extensive use, debate continues on their effectiveness due to the lack of well-designed, randomized, controlled studies to determine the effectiveness of epidural injections in general, and caudal epidural injections in particular. Study design A systematic review of caudal epidural injections with or without steroids in managing chronic Pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and Discogenic Pain without disc herniation or radiculitis. Objective To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back Pain with or without lower extremity Pain emanating as a result of disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and chronic Discogenic Pain. Methods The available literature on caudal epidural injections with or without steroids in managing various types of chronic low back Pain with or without lower extremity Pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for fluoroscopic observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome measures The primary outcome measure was Pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results For this systematic review, 73 studies were identified. Of these, 51 were excluded and a total of 16 studies met inclusion criteria for methodological quality assessment with 11 randomized trials and 5 non-randomized studies. For lumbar disc herniation, the evidence is good for short- and long-term relief of chronic Pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. In managing chronic axial or Discogenic Pain, spinal stenosis, and post surgery syndrome, the indicated evidence is fair. Limitations The limitations of this study include the paucity of literature, specifically for chronic Pain without disc herniation. Conclusion There was good evidence for short- and long-term relief of chronic Pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. Further, this systematic review also provided indicated evidence of fair for caudal epidural injections in managing chronic axial or Discogenic Pain, spinal stenosis, and post surgery syndrome.

Joshua A Hirsch - One of the best experts on this subject based on the ideXlab platform.

  • cervical interlaminar epidural injections in the treatment of cervical disc herniation post surgery syndrome or Discogenic Pain cost utility analysis from randomized trials
    Pain Physician, 2019
    Co-Authors: Laxmaiah Manchikanti, Allan T Parr, Vidyasagar Pampati, Maanasa V Manchikanti, Mahendra R Sanapati, Alan D Kaye, Joshua A Hirsch
    Abstract:

    Background Neck Pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck Pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck Pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). Objectives To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity Pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or Discogenic neck Pain. Study design Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or Discogenic Pain. Setting A contemporary, private, specialty referral interventional Pain management center in the United States. Methods Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical Discogenic or axial neck back Pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in Pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, Discogenic Pain, and cervical post-surgery syndrome. Results The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or Discogenic Pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. Limitations The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. Conclusion This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or Discogenic neck Pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. Key words Cervical interlaminar epidural injections, chronic neck Pain, cervical disc herniation, cervical Discogenic Pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years.

  • cost utility analysis of lumbar interlaminar epidural injections in the treatment of lumbar disc herniation central spinal stenosis and axial or Discogenic low back Pain
    Pain Physician, 2017
    Co-Authors: Laxmaiah Manchikanti, Ramsin M Benyamin, Joshua A Hirsch
    Abstract:

    BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional Pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity Pain secondary to lumbar disc herniation, spinal stenosis, and axial or Discogenic low back Pain. STUDY DESIGN: Analysis based on 3 previously published randomized trials of effectiveness of lumbar interlaminar epidural injections assessing their role in disc herniation, spinal stenosis, and axial or Discogenic Pain. SETTING: A contemporary, private, specialty referral interventional Pain management center in the United States. METHODS: Cost utility of lumbar interlaminar epidural injections with or without steroids in managing lumbar disc herniation, central spinal stenosis, and Discogenic or axial low back Pain was conducted with data derived from 3 RCTs that included a 2-year follow-up, with inclusion of 360 patients. The primary outcome was significant improvement defined as at least a 50% in Pain reduction and disability status. Direct payment data from 2016 was utilized for assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.6 to accommodate for indirect payments respectively for disc herniation, spinal stenosis, Discogenic Pain. RESULTS: The results of 3 RCTs showed direct cost utility for one year of quality-adjusted life year (QALY) of $2,050.87 for disc herniation, $2,112.25 for axial or Discogenic Pain without disc herniation, and $1,773.28 for spinal stenosis, with an average cost per one year QALY of $1,976.58, with total estimated costs of $3,425, $3,527, $2,961, and $3,301 respectively. LIMITATIONS: The limitation of this cost utility analysis includes that it is a single center evaluation, even though 360 patients were included in this analysis. Further, only the costs of interventional procedures and physician visits were assessed based on the data, with extrapolation of indirect costs presenting the overall total costs. The benefits of returning to work were not assessed. CONCLUSION: This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or Discogenic low back Pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.

  • an update on the management of chronic lumbar Discogenic Pain
    Pain management, 2015
    Co-Authors: Laxmaiah Manchikanti, Joshua A Hirsch
    Abstract:

    Lumbar degenerative disc disease without disc herniation, also known as Discogenic Pain, is an elusive diagnosis of chronic low back Pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar Discogenic Pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar Discogenic Pain. This review provides an updated assessment of the management of chronic lumbar Discogenic Pain with a critical look at the many modalities of treatments that are currently available.

  • what is the role of epidural injections in the treatment of lumbar Discogenic Pain a systematic review of comparative analysis with fusion
    The Korean Journal of Pain, 2015
    Co-Authors: Laxmaiah Manchikanti, Peter S Staats, Devi E Nampiaparampil, Joshua A Hirsch
    Abstract:

    BACKGROUND Lumbar Discogenic Pain without Pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent Pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing Discogenic Pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing Discogenic Pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. METHODS A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar Discogenic Pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. RESULTS Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. CONCLUSIONS The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity Pain for patients with lumbar Discogenic Pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.

Salahadin Abdi - One of the best experts on this subject based on the ideXlab platform.

  • caudal epidural injections in the management of chronic low back Pain a systematic appraisal of the literature
    Pain Physician, 2012
    Co-Authors: Allan T Parr, Laxmaiah Manchikanti, Ramsin M Benyamin, Ann Conn, Sudhir Diwan, Haroon Hameed, Kavita N Manchikanti, Vijay Singh, Salahadin Abdi
    Abstract:

    Background Epidural injections with local anesthetics and steroids are one of the most commonly used interventions in managing chronic low back Pain and lower extremity Pain of various causes. However, despite their extensive use, debate continues on their effectiveness due to the lack of well-designed, randomized, controlled studies to determine the effectiveness of epidural injections in general, and caudal epidural injections in particular. Study design A systematic review of caudal epidural injections with or without steroids in managing chronic Pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and Discogenic Pain without disc herniation or radiculitis. Objective To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back Pain with or without lower extremity Pain emanating as a result of disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and chronic Discogenic Pain. Methods The available literature on caudal epidural injections with or without steroids in managing various types of chronic low back Pain with or without lower extremity Pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for fluoroscopic observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome measures The primary outcome measure was Pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results For this systematic review, 73 studies were identified. Of these, 51 were excluded and a total of 16 studies met inclusion criteria for methodological quality assessment with 11 randomized trials and 5 non-randomized studies. For lumbar disc herniation, the evidence is good for short- and long-term relief of chronic Pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. In managing chronic axial or Discogenic Pain, spinal stenosis, and post surgery syndrome, the indicated evidence is fair. Limitations The limitations of this study include the paucity of literature, specifically for chronic Pain without disc herniation. Conclusion There was good evidence for short- and long-term relief of chronic Pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. Further, this systematic review also provided indicated evidence of fair for caudal epidural injections in managing chronic axial or Discogenic Pain, spinal stenosis, and post surgery syndrome.

  • Systematic review of caudal epidural injections in the management of chronic low back Pain.
    Pain physician, 2009
    Co-Authors: Ann Conn, Sukdeb Datta, Ricardo M. Buenaventura, Salahadin Abdi, Sudhir Diwan
    Abstract:

    BACKGROUND Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity Pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of caudal epidural injections in various conditions - disc herniation and radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic low back Pain of disc origin without disc herniation or radiculitis. STUDY DESIGN A systematic review of caudal epidural injections with or without steroids in managing chronic Pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and Discogenic Pain without disc herniation or radiculitis. OBJECTIVE To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back and lower extremity Pain emanating as a result of disc herniation or radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic Discogenic Pain. METHODS A review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was Pain relief (short-term relief = up to 6 months and long-term > or = 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. RESULTS The evidence showed Level I for short- and long-term relief in managing chronic low back and lower extremity Pain secondary to lumbar disc herniation and/or radiculitis and Discogenic Pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back Pain of post-lumbar laminectomy syndrome and spinal stenosis. LIMITATIONS The limitations of this study include the paucity of literature, specifically for chronic Pain without disc herniation. CONCLUSION This systematic review shows Level I evidence for relief of chronic Pain secondary to disc herniation or radiculitis and Discogenic Pain without disc herniation or radiculitis. Further, the indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing chronic Pain of post lumbar laminectomy syndrome and spinal stenosis.

  • lumbar interlaminar epidural injections in managing chronic low back and lower extremity Pain a systematic review
    Pain Physician, 2009
    Co-Authors: Allan T Parr, Sudhir Diwan, Salahadin Abdi
    Abstract:

    BACKGROUND Low back Pain with or without lower extremity Pain is the most common problem among chronic Pain disorders with significant economic, societal, and health impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back Pain. However the evidence is highly variable among different techniques utilized - namely interlaminar, caudal, transforaminal - and for various conditions, namely - intervertebral disc herniation, spinal stenosis, and Discogenic Pain without disc herniation or radiculitis. STUDY DESIGN A systematic review of lumbar interlaminar epidural injections with or without steroids. OBJECTIVE To evaluate the effect of lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back and lower extremity Pain emanating as a result of disc herniation or radiculitis, spinal stenosis, and chronic Discogenic Pain. METHODS Review of the literature and methodologic quality assessment were performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Results of analysis were performed for multiple conditions separately. OUTCOME MEASURES The primary outcome measure was Pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS The available literature included only blind epidural injections without fluoroscopy. The indicated evidence is positive (Level II-2) for short-term relief of Pain of disc herniation or radiculitis utilizing blind interlaminar epidural steroid injections with lacking of evidence with Level III for long-term relief for disc herniation and radiculitis. The evidence is lacking with Level III for short and long-term relief for spinal stenosis and Discogenic Pain without radiculitis or disc herniation utilizing blind epidural injections. LIMITATIONS The limitations of this study include paucity of literature, lack of quality evidence, lack of fluoroscopic procedures, and lack of applicable evidence in contemporary interventional Pain management practices. CONCLUSION The evidence based on this systematic review is limited for blind interlaminar epidurals in managing all types of Pain except for short-term relief of Pain secondary to disc herniation and radiculitis. This evidence does not represent contemporary interventional Pain management practices and also the evidence may not be extrapolated to fluoroscopically directed lumbar interlaminar epidural injections.

  • diagnosis and minimally invasive treatment of lumbar Discogenic Pain a review of the literature
    The Clinical Journal of Pain, 2006
    Co-Authors: Yili Zhou, Salahadin Abdi
    Abstract:

    Diagnosis and treatment of lumbar Discogenic Pain due to internal disc disruption (IDD) remains a challenge. It accounts for 39% of patients with low back Pain. The mechanism of Discogenic Pain remains unclear and its clinical presentation is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of IDD. However, relative low sensitivity (26.7% to 59%) and high false-positive (24%) and false-negative (38%) rates reduce the value of MRI in screening for the existence of Painful IDD. Provocative discography can provide unique information about the Pain source and the morphology of the disc. It may also provide information for selecting appropriate treatment for the Painful annular tear. Adjunctive therapies, including nonsteroidal anti-inflammatory drugs, physical therapy, rehabilitation, antidepressants, antiepileptics, and acupuncture, have been used for low back Pain. The value of these treatments for Discogenic Pain is yet to be established. Intradiscal steroid injection has not been proved to provide long-term benefits. Intradiscal electrothermal therapy may offer some Pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. A block in the ramus communicans may interfere with the transition of Painful information from the discs to the central nervous system. Disc cell transplantation is in the experimental stage. It has the potential to become a useful tool for the prevention and treatment of Discogenic Pain. Minimally invasive treatments provide alternatives for Discogenic Pain with the appeal of cost-effectiveness and, possibly, less long-term side effects. However, the value of most of these therapies is yet to be established. More basic science and clinical studies are needed to improve the clinical efficacy of minimally invasive treatments.

Kimberly A Cash - One of the best experts on this subject based on the ideXlab platform.

  • Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial
    2014
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Vidyasagar Pampati, Yogesh Malla
    Abstract:

    licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Received: 2013.11.06; Accepted: 2014.01.01; Published: 2014.02.06 Study Design: A randomized, double-blind, active-controlled trial. Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or Discogenic Pain in patients without disc herniation, radiculitis, or facet joint Pain. Summary of Background Data: Cervical Discogenic Pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint Pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck Pain. Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint Pain as determined by means of controlled diagnostic medial branch blocks wer

  • two year follow up results of fluoroscopic cervical epidural injections in chronic axial or Discogenic neck Pain a randomized double blind controlled trial
    International Journal of Medical Sciences, 2014
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Yogesh Malla
    Abstract:

    Study Design: A randomized, double-blind, active-controlled trial. Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or Discogenic Pain in patients without disc herniation, radiculitis, or facet joint Pain. Summary of Background Data: Cervical Discogenic Pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint Pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck Pain. Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint Pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone. The primary outcome measure was ≥ 50% improvement in Pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight. Results: Significant Pain relief and functional improvement (≥ 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in Pain and functioning in patients with chronic Discogenic or axial Pain that is function-limiting and not related to facet joint Pain.

  • a randomized double blind active controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or Discogenic low back Pain results of 2 year follow up
    Pain Physician, 2013
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Carla D Mcmanus, Ramsin M Benyamin
    Abstract:

    BACKGROUND Chronic low back with or without lower extremity Pain is extremely common, expensive, and disabling. However, all modalities of treatments are directed towards disc herniation which is responsible for a very small proportion of the patients. Thus, chronic low back Pain without disc herniation is common. Multiple modalities of treatments are utilized in managing axial or Discogenic Pain including surgery and epidural injections including surgery, intradiscal therapies, and epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of all modalities treatments in managing axial or Discogenic Pain in the lumbar spine. STUDY DESIGN A randomized, double-blind, active control trial. SETTING A private practice, specialty referral, interventional Pain management practice in the United States. OBJECTIVES To evaluate the ability to assess the effectiveness of lumbar interlaminar epidural injections in managing chronic axial or Discogenic low back Pain with epidural injections of local anesthetic with or without steroids. METHODS In this study, a total of 120 patients were randomly allocated to one of the 2 groups receiving either local anesthetic alone or local anesthetic with steroids with 60 patients in each group. The primary outcome measure was at least 50% improvement in the numeric rating scale (NRS) and Oswestry Disability Index (ODI). Outcomes were assessed at 3, 6, 12, 18, and 24 months post treatment. RESULTS Significant Pain relief and functional status improvement defined as at least 50% or more reduction in scores from baseline were observed in 72% of patients receiving local anesthetic alone and 67% of the patients receiving local anesthetic with steroids. Opioid intake was reduced from baseline in each group for 2 years. LIMITATIONS The results of the study are limited by the lack of a placebo group. CONCLUSION Lumbar interlaminar epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back Pain of Discogenic origin without facet joint Pain, disc herniation, and/or radiculitis. TRIAL REGISTRATION NCT00681447.

  • fluoroscopic caudal epidural injections in managing chronic axial low back Pain without disc herniation radiculitis or facet joint Pain
    Journal of Pain Research, 2012
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Carla D Mcmanus, Vidyasagar Pampati
    Abstract:

    Background Chronic low back Pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or Discogenic Pain, including epidural injections.

  • fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or Discogenic Pain
    Journal of Pain Research, 2012
    Co-Authors: Laxmaiah Manchikanti, Kimberly A Cash, Vidyasagar Pampati, Carla D Mcmanus, Ramsin M Benyamin
    Abstract:

    Among the multiple causes of chronic low back Pain, axial and Discogenic Pain are common. Various modalities of treatments are utilized in managing Discogenic and axial low back Pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or Discogenic Pain, including epidural injections. In an interventional Pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back Pain of Discogenic origin. However, disc herniation, radiculitis, facet joint Pain, or sacroiliac joint Pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the Pain relief-assessed by numeric rating scale of Pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in Pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back Pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or Discogenic Pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the Pain source.