Poster 197: Is Opioid Use a Factor in Response to Epidural Steroid Injection for Radicular Low Back Pain?

Abstract

Objective: To determine the predictive value of opioid use in the response to epidural steroid injection. Design: Retrospective chart review. Setting: University hospital outpatient clinic. Participants: 53 consecutive patients who received a transforaminal epidural steroid injection for diagnosis of radiculopathy seen over 2 years. Mean age was 48 years, with 28 men and 25 women. 19 of the 53 patients were using opioids at the time of the injection. Intervention: Each patient underwent a fluoroscopically guided transforaminal epidural injection with 3mL solution of 2mL of 80mg of triamcinolone and 1mL of 1% lidocaine. Needle placement was confirmed by injecting 0.5mL of Omnipaque 240 contrast dye. Main Outcome Measure: A positive response to the injection was defined as the absolute change between pre- and postinjection visual analog scale (VAS) scores. Results: 74% of patients on opioids had improved VAS scores after injections, while 71% of patients without opioids had improvement. Using the analysis of variance F test, there was no significant relationship between concurrent opioid use and a lack of response to epidural steroid injections (P=.066). Conclusions: Our study indicates that fluoroscopically guided epidural steroid injection is an effective treatment for radicular low back pain in patients using opioids. Opioids can induce central sensitization, and may affect the clinical response to epidural steroid injections, however, these results demonstrate that current opioid use should not be a deterrent to epidural steroid injection. This study is limited by a low power and larger studies would be beneficial.