Primary studies included in this systematic review

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12 articles (12 References) loading Revert Studify

Primary study

Unclassified

Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study.

Journal Pain
Year 1992
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This article is included in 7 Systematic reviews Systematic reviews (7 references)

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This paper describes a prospective, double blind, randomised and dummy-controlled trial in 28 patients with chronic mechanical low back pain presenting to the York Pain Clinic. The therapeutic effects of epidural methyl prednisolone (80 mg) were compared with intrathecal midazolam (2 mg). All the patients had pain for a considerable length of time (range: 1-35 years) and all had received previous treatments which had failed. The two groups of patients were comparable in terms of pain duration, demography, extent of disability, anxiety and depression and pain locus of control. The pain was assessed before and for 2 months after treatment using the short form McGill Pain Questionnaire as well as visual analogue and verbal rating scales for sensory and affective components of their pain experience; patients also completed a pain diary. Both treatments caused a similar improvement in one-half to three-quarters of the patients for 2 months in patterns of activity and sleep as well as in the sensory and affective components of the pain. However, although the improvement in the two groups was similar, all the patients treated with steroid were either taking more or the same amount of self-administered analgesic medication after their treatment, whereas between one-third and one-half of the midazolam-treated patients took less medication during the 2 month follow-up period. We conclude that intrathecal midazolam is an effective treatment for chronic mechanical low back pain. The mechanism responsible for this effect is discussed.

Primary study

Unclassified

A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica.

Authors Bush K , Hillier S
Journal Spine
Year 1991
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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The management of sciatica due to lumbar nerve root compromise remains controversial, probably because few well-controlled studies of conservative management have been performed. This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5% procaine hydrochloride in saline, administered via the caudal route, in a double-blind, placebo controlled trial with 1 year follow-up. Twenty-three patients were entered into the study: 12 received treatment and 11 placebo. The active group showed significant pain relief (P = 0.02) and a significant increase in mobility (P = 0.01) at 4 weeks, which resulted in improved quality of life (P = 0.02). At 1 year, subjective and objective measures improved in both groups. The improvement was greater in the actively treated group, but only the objective assessment (straight leg raise) was statistically significant.

Primary study

Unclassified

Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome.

Journal Pain
Year 1989
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This article is included in 6 Systematic reviews Systematic reviews (6 references)

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Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

Primary study

Unclassified

Outpatient lumbar epidural corticosteroid injection in the management of sciatica.

Journal British journal of rheumatology
Year 1988
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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The value of epidural injections of corticosteroid as an outpatient treatment of sciatica has been hitherto uncertain. An epidural injection of 80 mg methylprednisolone in 10 ml physiological saline was compared with an interspinous injection of 2 ml physiological saline in a double blind fashion amongst 39 outpatients. Significant differences of pain relief were seen between the two groups within 2 weeks. This benefit disappeared for six (35%) patients within 6 months of treatment although 11 (65%) successfully treated subjects had sustained improvement up to this time. Outpatient epidural injections of corticosteroid are thus a useful short-term means of relieving pain in sciatica but probably have little effect on the long-term natural history of symptoms. Factors associated with a failure to respond to epidural steroid injections are discussed.

Primary study

Unclassified

Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections.

Journal British journal of rheumatology
Year 1987
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This article is included in 15 Systematic reviews Systematic reviews (15 references)

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Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated. The largest group studied had low back pain with limited straight-leg raising (SLR) and in them the beneficial effect of manipulation in hastening pain relief was highly significant. In similar patients without limitation of SLR, the effect was of borderline significance. In all the other groups, treated patients also recovered more quickly than their controls. Traction, for patients with low back pain and sciatica, and epidural injections when a root palsy was present also produced some significant pain relief. The effect of sclerosants for back pain was less clear.

Primary study

Unclassified

The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.

Journal The Journal of bone and joint surgery. American volume
Year 1985
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This article is included in 13 Systematic reviews Systematic reviews (13 references) 1 Broad synthesis Broad syntheses (1 reference)

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Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. No statistically significant difference was observed between the control and experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.

Primary study

Unclassified

Lumbar epidural injections in the treatment of sciatica.

Journal British journal of rheumatology
Year 1984
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This article is included in 5 Systematic reviews Systematic reviews (5 references)

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A randomized trial of lumbar epidural injections for the treatment of acute sciatic pain was carried out. All the patients had unilateral sciatica for less than six months and had never previously been treated in hospital for their backs. The treatments used were 20 ml normal saline, 80 mg Depomedrone in normal saline made up to 20 ml, 20 ml, 20 ml 0.25% bupivacaine solution and needling with a standard Touhy injection needle into the interspinous ligament but with no injection. The patients improved at about the same rate for all four treatments. Overall, 75% of the patients improved or were cured. As some of these were in the group treated by needling of the interspinous ligament, it seems likely that the epidural injections administered achieved effects partially as a placebo and partially by virtue of the natural history of the acute sciatic syndrome.

Primary study

Unclassified

A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica.

Authors Yates DW
Journal Rheumatology and rehabilitation
Year 1978
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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Primary study

Unclassified

Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs.

Authors Snoek W , Weber H , Jørgensen B
Journal Acta orthopaedica Scandinavica
Year 1977
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This article is included in 8 Systematic reviews Systematic reviews (8 references)

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A double blind study was carried out in 51 patients suffering from lumbar root compression syndrome of 12 days to 36 weeks duration. All patients had signs, symptoms and radiological abnormalities related to a herniated lumbar disc. Each patient received an extradural injection of either 2 ml (80 mg) methyl prednisolone or 2 ml normal saline solution. Neurological examination and interview of the patients with the aid of a questionnaire before and after extradural injection failed to demonstrate any statistically significant difference in outcome between the two groups. At follow-up 14 +/- 6 months after extradural injection 58.3 per cent of the patients in the control group and 51.9 per cent of the patients in the treatment group had undergone surgical treatment with laminectomy. Our results indicate that a single extradural injection of methyl prednisolone (80 mg) is no more effective than a placebo injection in relieving chronic symptoms due to myelographically demonstrable lumbar disc herniation.

Primary study

Unclassified

Treatment of chronic low back pain and sciatica. Comparison of caudal epidural injections of bupivacaine and methylprednisolone with bupivacaine followed by saline

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Book In: Bonica JJ, AlbeFesard D (eds). Advances in pain research and therapy. Vol. 1. Raven Press, New York
Year 1976

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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