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pISSN 2005-9159
eISSN 2093-0569
eISSN 2093-0569
Korean J Pain 2015; 28(2): 75-87
Published online April 1, 2015 https://doi.org/10.3344/kjp.2015.28.2.75
Copyright © The Korean Pain Society.
Laxmaiah Manchikanti*, Peter S. Staats*, Devi E. Nampiaparampil†, and Joshua A. Hirsch‡
Pain Management Center of Paducah, Paducah, and University of Louisville, Louisville, KY, USA.
*Premier Pain Centers, Shrewsbury, NJ, and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
†New York University School of Medicine, New York, NY, USA.
‡Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Correspondence to: Laxmaiah Manchikanti. Pain Management Center of Paducah, Paducah, and University of Louisville, Louisville, 2831 Lone Oak Road, Paducah, Kentucky 42003, USA. Tel: +1-270-554-9412, Fax: +1-270-554-8987, drlm@thepainmd.com
Received: January 21, 2015; Revised: March 7, 2015; Accepted: March 13, 2015
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
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.
Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar.
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.
Keywords: Discogenic pain, Epidural injections, Lumbar disc arthroplasty, Lumbar fusion, Randomized trials
