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A Survey among Texas Pain Society Physicians Regarding the Types and Dosages of Steroids Utilized Clinically in Epidural Steroid Injectates

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DOI: 10.4236/ojanes.2014.411042    2,754 Downloads   3,434 Views   Citations

ABSTRACT

Objective: Epidural steroid injections (ESI) are used extensively to treat radicular back pain. This study is designed to evaluate the types and dosages of steroids commonly used and understand prescribing habits of the Texas Pain Society pain management physicians. Method: From April to May 2014, we sent all 270 Texas Pain Society members a questionnaire to complete online. We collected 45 responses. Result: Type of steroid commonly used in injectate: Eighteen (41.9%) phy-sicians reported using methylprednisolone most. Fifteen (34.9%) physicians use triamcinolone, 9 (20.9%) physicians use dexamethasone, 1 (2.3%) uses betamethasone, and 2 skipped this question. Important factors influencing the type of steroid use in injectate: Half of the physicians reported that the location of the ESI was most important (19 responses, 48.7%). Ten (25.6%) reported that the approach of the ESI was most important. Another ten (25.6%) agreed that the potency of the steroid was most important. Dosage of steroid used in injectate: About half of the physicians use a fixed dose of steroid (22, 51.2%) while 21 (48.8%) use a variable dose of steroid. Of those who use a fixed dose of steroid, many use methylprednisolone 80 mg (9, 39.1%). Of those who use a variable dosage of steroid, the most important factor in their determination of the dosage is the patient’s comorbidities (20 responses, 58.8%). The use of depo-steroid in injectate: Thirty-two out of 43 (74.4%) use depo-steroid while 11 out of 43 (25.6%) wouldn’t use depo-steroid. Of those who use depo-steroid, the duration and availability in the epidural space is the most common reason for its use (23, 76.7%). Conclusion: By using a simple questionnaire detailing what types and dosages of steroids are used, compiling a list of best practices can help Texas Pain Society physicians tremendously in the treatment of radicular back pain.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Dao, T. and Skaribas, I. (2014) A Survey among Texas Pain Society Physicians Regarding the Types and Dosages of Steroids Utilized Clinically in Epidural Steroid Injectates. Open Journal of Anesthesiology, 4, 291-299. doi: 10.4236/ojanes.2014.411042.

References

[1] Stanczak, J., Blankenbaker, D.G., De Smet, A.A. and Fine, J. (2003) Efficacy of Epidural Injections of Kenalog and Celestone in the Treatment of Lower Back Pain. American Journal of Roentgenology, 181, 1255-1258.
http://dx.doi.org/10.2214/ajr.181.5.1811255
[2] Blankenbaker, D.G., De Smet, A.A., Stanczak, J. and Fine, J. (2005) Lumbar Radiculopathy: Treatment with Selective Lumbar Nerve Blocks—Comparisons of Effectiveness of Triamcinolone and Betamethasone Injectable Suspensions. Radiology, 237, 738-741.
http://dx.doi.org/10.1148/radiol.2372041406
[3] Weinstein, S.M. and Herring, S.A. (2003) Lumbar Epidural Steroid Injections. The Spine Journal, 3, 37-44.
http://dx.doi.org/10.1016/S1529-9430(02)00560-0
[4] Koes, B.W., Scholten, R.J.P.M., Jens, J.M.A. and Bouter, L.M. (1995) Efficacy of Epidural Steroid Injections for LowBack Pain and Sciatica: A Systemic Review of Randomized Clinical Trials. Pain, 63, 279-288.
http://dx.doi.org/10.1016/0304-3959(95)00124-7
[5] DePalma, M.J. and Slipman, C.W. (2008) Evidence-Informed Management of Chronic Low Back Pain with Epidural Steroid Injections. The Spine Journal, 8, 45-55.
http://dx.doi.org/10.1016/j.spinee.2007.09.009
[6] Colimon, F.J. and Villalobos, F.J. (2010) Epidural Steroid Injections: Evidence and Technical Aspects. Techniques in Regional Anesthesia and Pain Management, 14, 113-119.
http://dx.doi.org/10.1053/j.trap.2010.06.001
[7] McLain, R.F., Kapural, L. and Mekhail, N.A. (2005) Epidural Steroid Therapy for Back and Leg Pain: Mechanisms of Action and Efficacy. The Spine Journal, 5, 191-201.
http://dx.doi.org/10.1016/j.spinee.2004.10.046
[8] Hession, W.G., Stanczak, J.D., Davis, K.W. and Choi, J.J. (2004) Epidural Steroid Injections. Seminars in Roentgenology, 39, 7-23.
http://dx.doi.org/10.1016/j.ro.2003.10.010
[9] Kushnerik, V., Altman, G. and Gozenput, P. (2009) Pharmacology of Steroids Used during Epidural Steroid Injections. Techniques in Regional Anesthesia and Pain Management, 13, 212-216. http://dx.doi.org/10.1053/j.trap.2009.07.004
[10] Kim, D. and Brown, J. (2011) Efficacy and Safety of Lumbar Epidural Dexamethasone versus Methylprednisolone in the Treatment of Lumbar Radiculopathy: A Comparison of Soluble versus Particulate Steroids. The Clinical Journal of Pain, 27, 518-522.
http://dx.doi.org/10.1097/AJP.0b013e31820c53e0
[11] Kennedy, D.J., Plastaras, C., Casey, E., Visco, C.J., Rittenberg, J.D., Conrad, B., Sigler, J. and Dreyfuss, P. (2014) Comparative Effectiveness of Lumbar Transforaminal Epidural Steroid Injections with Particulate versus Nonparticulate Corticosteroids for Lumbar Radicular Pain Due to Intervertebral Disc Herniation: A Prospective, Randomized, Double-Bind Trial. Pain Medicine, 15, 548-555.
http://dx.doi.org/10.1111/pme.12325
[12] Valat, J.P. and Rozenberg, S. (2008) Local Corticosteroid Injections for Low Back Pain and Sciatica. Joint Bone Spine, 75, 403-407.

  
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