Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Epidural injections have been used for pain relief since the 1880s. Corticosteroids are antiinflammatory medications that can alleviate pain, but also have harmful systemic adverse effects. Literature regarding methylprednisolone dosage efficacy is limited.
OBJECTIVES: To determine the lowest effective dose of methylprednisolone in a lumbar epidural steroid injection (LESI) for maximal pain relief without exposing patients to adverse events caused by steroid use.
STUDY DESIGN: Retrospective chart review.
SETTING: Outpatient interventional pain clinic at an academic center.
METHODS: Adults (n = 133), aged 18 to 85 years, with low-back pain and radicular symptoms treated with LESI from August 2011 to November 2015. Patients who received prior cervical epidural steroid injections were excluded. Interventions were
LESI with methylprednisolone 40 mg, 80 mg, or 120 mg. Main outcome measures showed change in pain score using a numeric pain scale (NPS; 0 = no pain, 10 = excruciating pain), and patient’s self-reported reduction in pain (percentage), pre- and postprocedure. The primary endpoint measurement was 2 weeks postinjection. Adverse effects were recorded.
RESULTS: The number of patients who received each dose varied: n = 88 received 120 mg, n = 30 received 80 mg, and n = 13 received 40 mg. The NPS pain scores pre- and postprocedure for 120 mg were 8.89 ± 1.32 and 4.08 ± 3.74, (mean ± standard deviation), respectively; for 80 mg: 9.06 ± 1.00 and 3.75 ± 4.00; and for 40 mg: 9.00 ± 1.00 and 4.00 ± 0.00. Percentage of pain relief for 120 mg, 80 mg, and 40 mg was 57.26%, 50.74%, and 57.26, respectively (P = 0.3347). n = 4 experienced adverse effects, all received 120 mg.
CONCLUSIONS: All 3 dosage groups had similar efficacy in pain relief, but only patients who received 120 mg experienced adverse effects. This demonstrates that lower dosages can be used for pain relief with less potential harm to the patient.
KEY WORDS: Methylprednisolone, interlaminar epidural, radiculopathy