Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-07-10
Introduction
Spinal
pain is the most common of all chronic pain disorders. The number of
individuals that have, at some point in their life, experienced spinal
pain has been reported as 54 to 80%. After the initial painful episode,
the prevalence of persistent low back and neck pain ranges from 26 to
75%.
Axial
(neck or low back pain) and radicular pain (radiating pain to arm or
leg) may arise from any anatomic structure capable of transmitting pain
(the pain generator). Pain generators include vertebral
discs, nerve roots, dura (the outer layer of membrane surrounding the
brain and spinal cord), muscles, fascia (soft, connective tissue),
ligaments, and facet joints. Injury to any of these structures results
in the release of inflammatory mediators. Epidural injection of steroid
(cortisone, corticosteroid) is one of the most commonly used
interventions to decrease the inflammation in managing persistent spinal
pain.
Historically,
the epidural steroid injection is the first-line invasive therapeutic
procedure of choice in patients with spinal pain. In 1901, the first
independent reports on the use of caudal epidural injections in the
treatment of lumbar nerve root compression were published. The first
reportedly successful use of lumbar epidural injections as a treatment
for sciatica was in 1909. In 1930, a success rate of 61% was reported
for the treatment of sciatica following the caudal injection of large
volumes of local anesthetic and saline. The first reported use of
epidural steroids was in 1957 as a treatment for radicular leg pain.