Abstract
Introduction: The physical, socioeconomic and psychological burden of low back pain is enormous. The poor socioeconomic condition and geographical constrains confines people to limited health facilities. The objective of the study was to evaluate whether combination of caudal epidural steroids with local anaesthetics and gabapentin is effective for radicular low back pain in the rural Nepal setting.
 Methods: It was a prospective observational study including 300 patients with radicular low back pain done over a period of 6 months (13/4/2016 to 30/10/2016). All participants received caudal epidural steroid injection (6ml 2% Xylocaine with adrenaline plus Depomedroxy steroid 80mg plus 12 ml distilled water) and 200 mg gabapentin daily for three months. All patients were followed up for three months and were evaluated.
 Results: Mean age of presentation was 41.21 years (SD ± 11.02) with majority of farmers (42.31%). Mean Numerical Rating Scale at the baseline was 8.01(SD±1.00) and at the first follow up was 3.98 (SD±0.83) (p <0.001). Mean Oswestry Disability Index at baseline was7.85 (SD±0.98) and at the first follow up was 4.04 (SD±0.80) (p <0.001). Straight Leg Raising Test at baseline was less than 70° in 84.7% which improved to more than 70° in 87.9% of the patients (p-value <0.001).
 Conclusion: Caudal epidural steroids combined with gabapentin is safe, economical and technically less demanding. This treatment modality can be used with good outcomes in the rural areas with limited diagnostic and therapeutic facilities.
Highlights
The physical, socioeconomic and psychological burden of low back pain is enormous.The poor socioeconomic condition and geographical constrains confines people to limited health facilities
Out of 300 total patients who were enrolled for the study, 17 patients had pain for more than 3 months and were excluded from the study
Out of remaining 283 patients, 9 patients had no pain relief after the first dose of epidural steroid injection and they were subjected to further investigation like MRI
Summary
The physical, socioeconomic and psychological burden of low back pain is enormous.The poor socioeconomic condition and geographical constrains confines people to limited health facilities. The objective of the study was to evaluate whether combination of caudal epidural steroids with local anaesthetics and gabapentin is effective for radicular low back pain in the rural Nepal setting. Epidural corticosteroid injections have been reported to be used frequently in the clinical practice to treat sciatica for the last 50 years, but still its use is controversial.[4] As stated by Manchikanti et al the evidence for all three modalities of caudal injection that is caudal epidural, interlaminar epidural, and transforaminal epidural injections is good in managing disc herniation or radiculitis.[5] there is no proven additional benefit of local anaesthetics steroid injections commonly include a local anesthetic to avoid pain from the injection.[6] Most controlled studies have found pharmacotherapy with gabapentinoids as an effective treatment modality for lumbosacral radicular pain.[7,8] As gabapentin prevents central sensitization, consideration should be given to prescribing this drug early in the course of sciatica.[1]
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