Abstract
Corticosteroids have played a standard role in the multimodal pain management in the treatment of chronic spinal pain (cervical and lumbar) and osteoarthritis pain over the past three decades. In this review we discuss different types of injectable steroids that are mainly used for injection into the epidural space (for the treatment of radicular back and neck pain), and as intra-articular injections for different types of osteoarthritis related pain conditions. Furthermore, we discuss different approaches taken for epidural corticosteroid injections and spinal surgical rates when injections fail to resolve painful conditions, as well as the possibility of using local anesthetics alone for neuraxial injections, instead of in combination with corticosteroids. While we present some beneficial effects of newly available treatment options for low back pain and osteoarthritis pain, such as use of PRP and hyaluronic acid, corticosteroids remain important considerations in the management of these chronic pain conditions.
Highlights
CORTICOSTEROIDS AND PAINWhile glucocorticoid steroids have historically been identified for centuries, the focus on their role in painful conditions has been incomplete
While we present some beneficial effects of newly available treatment options for low back pain and osteoarthritis pain, such as use of PLATELET RICH PLASMA (PRP) and hyaluronic acid, corticosteroids remain important considerations in the management of these chronic pain conditions
Intra-articular platelet-rich plasma (IA-PRP) injection led to significant improvements in patient outcomes (WOMAC score, IKDC score, Lequesne index) and led to greater increases in the pooled effect size versus treatment with control (HA or NS) at 6 months after injection Patients taking steroids had better VAS pain scores up to 1 month after injection compared to patients taking hyaluronic acid; at 6 months the reverse was true
Summary
While glucocorticoid steroids have historically been identified for centuries, the focus on their role in painful conditions has been incomplete. One rationale for this limited role could be our understanding that the benefits of the anti-inflammatory properties of steroids in pain management are exclusively supplementary to other therapies employed. Intramuscular, intravenous, transcutaneous, and neuraxial administration of corticosteroids has, over the past 30 years, been used in the management of different degenerative disease states (cervical and lumbar degenerative disease, osteoarthritis, etc.). Corticosteroids in Chronic Pain Management pain management evolution from using oral steroids to fluoroscopically-guided epidural and transforaminal steroid injection techniques, research was begun to implement an algorithm for using the most superior methods of relieving back pain and radicular pain. Special emphasis will be placed on the relationship of incorporating our literature review and formulating clinical decision-making, thereby acknowledging the need for identifying additional improvements in currently published pain management guidelines
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