PT  - JOURNAL ARTICLE
AU  - Bartynski, W.S.
AU  - Jennings, R.B.
AU  - Rothfus, W.E.
AU  - Agarwal, V.
TI  - Immediate Pain Response to Interlaminar Lumbar Epidural Steroid Administration: Response Characteristics and Effects of Anesthetic Concentration
AID  - 10.3174/ajnr.A3170
DP  - 2013 Jan 01
TA  - American Journal of Neuroradiology
PG  - 239--246
VI  - 34
IP  - 1
4099  - http://www.ajnr.org/content/34/1/239.short
4100  - http://www.ajnr.org/content/34/1/239.full
SO  - Am. J. Neuroradiol.2013 Jan 01; 34
AB  - BACKGROUND AND PURPOSE: Interlaminar LESIs are commonly used to treat LBP or radiculopathy. Most studies focus on the long-term outcomes of LESI. The purpose of this study is to evaluate the immediate effects of fluoroscopically guided LESI on LBP/radiculopathy including low- or high-strength anesthetic response. MATERIALS AND METHODS: The procedure notes, post-procedure records, and imaging records dedicated spine nurse assessments, and imaging records were retrospectively evaluated in 392 fluoroscopically guided LESIs performed in 276 patients (nonrandomized, nonblinded; 131 males, 145 females; average age, 56 years) with LBP/radiculopathy using either low- or high-strength anesthetic (80 mg of methylprednisilone mixed with bupivacaine [0.25% or 0.5%]). Post-procedure documentation of the patient's pre- and postprocedure VAS pain-scale level were tabulated. RESULTS: Single LESI was performed in 199 patients, with multiple LESIs in 77 (193 injections). Low-strength bupivacaine (0.25%) was used in 237 injections, with high-strength (0.5%) in 155. Complete to near-complete immediate pain relief (<20% residual pain) was reported after 197 of 392 (50.3%) injections. No pain relief was reported after 60 (15.4%) injections (>80% residual), with partial relief in the remainder. No statistical difference was noted between low- and high-anesthetic strength or between single- and multiple-injection patients. In multiple-LESI patients, consistent pain relief response was noted in 39 of 77 (50.6%) patients, with improving LESI response in 20.8%, deteriorating LESI response in 19.5%, and variable response in 9.1%. CONCLUSIONS: An immediate pain-extinction response is identified after LESI, which appears independent of anesthetic strength. This observation may relate to pain origin and/or pain nociceptor afferent pathway in an individual patient and potentially relate to treatment response. APanteroposteriorDRGdorsal root ganglionLBPlow back painLESIlumbar epidural steroid injectionVASVisual Analog Scale