Indications for epidural steroids in axial low back pain?

[painquestions8989]

1. Post-laminectomy syndrome with axial pain?
2. Does axial low back pain with radiation into the hips, buttocks, or groin, with stenosis on imaging, count as radiculopathy and/or warrant epidural steroids?
3. I've seen discogenic pain as an indication for epidural steroids, however if this is not producing frank radiculopathy, does this warrant epidural steroids?
4. Does low back pain radiating into the hips/buttocks/groin, occurring with walking, count as neurogenic claudication and warrant epidural steroids?

Thank you for your insight!

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[clubdeac]

1. Post-laminectomy syndrome with axial pain?
2. Does axial low back pain with radiation into the hips, buttocks, or groin, with stenosis on imaging, count as radiculopathy and/or warrant epidural steroids?
3. I've seen discogenic pain as an indication for epidural steroids, however if this is not producing frank radiculopathy, does this warrant epidural steroids?
4. Does low back pain radiating into the hips/buttocks/groin, occurring with walking, count as neurogenic claudication and warrant epidural steroids?

Thank you for your insight!

Yes on all the above

 

[MD87]

Most (all?) insurances consider ESI to be “experimental” for axial pain alone.

Some studies show that ESI is helpful for discogenic pain (most by the same authors). The majority do not.

My experience is consistent with the research, which dictates that ESI tends to be much more helpful for radiating than axial pain. Of course, there are exceptions, and some patients (less than half) do have significant reduction in axial pain with ESI.

 

[CleanUp]

When on the fence I consider it a low risk high reward procedure. And I don’t discount the insane percentage from a placebo effect.

 

[paindoc503]

for axial discogenic pain - what else would you offer them if not for an ESI? most surgeons won't touch them unless they've at least tried an epidural. you're only other option is PT and medications

same thing applied for lumbar stenosis. the data isn't great but most surgeons won't even consider surgery unless they've tried an epidural, at least in my area

 

[lobelsteve]

No pain below the back, no epidural.

 

[clubdeac]

If they have any pain in the hip area or buttock with either central stenosis or any neurocompression, I target the area with an epidural. Agree that pure axial lbp is iffy but if they have central stenosis and facets have been ruled out, I’ll try one. I’ve been pleasantly surprised

 

[Ducttape]

many insurances will not pay for axial only pain.

pain radiating to the buttocks is in essence radicular pain.

for discogenic pain - MBB RFA might be an option. Intracept. however, the primary treatment is HEP and cognitive therapies.

 

[RoloTomassi]

Doesn't hurt to try epidural.
Intracept if Modic.
Anything else is riskier and more questionable.
ViaDisc.
Allogenic stem cell products coming soon--Mesoblast, Discgenics.
Further in the pipeline--Hydrafil.
Intradiscal PRP, BMAC.

 

[clubdeac]

many insurances will not pay for axial only pain.

pain radiating to the buttocks is in essence radicular pain.

for discogenic pain - MBB RFA might be an option. Intracept. however, the primary treatment is HEP and cognitive therapies.

For discogenic pain - mbb RFA might be an option? Did I read that wrong? Since when do we treat discogenic pain with mbb’s?

 

[Ducttape]

generally i dont, but it might be an option if i have concerns that there is concurrent facet mediated symptoms.

 

[sdnuser001]

If they have any pain in the hip area or buttock with either central stenosis or any neurocompression, I target the area with an epidural. Agree that pure axial lbp is iffy but if they have central stenosis and facets have been ruled out, I’ll try one. I’ve been pleasantly surprised

Agreed it def helps for the axial component of neurogenic claudication IME. Same for annular tears.

 

[gaseous_clay]

for axial discogenic pain - what else would you offer them if not for an ESI? most surgeons won't touch them unless they've at least tried an epidural. you're only other option is PT and medications

same thing applied for lumbar stenosis. the data isn't great but most surgeons won't even consider surgery unless they've tried an epidural, at least in my area

ViaDisc