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Epidural Steroid Injections Decrease Length Of Stay, Reduce Opioid Requirements, And Prevent Admission For Patients Presenting To The Emergency Department With Back Pain 2013

Category Interventional Jeffrey Gilligan
Allan L. Brook, MD
Todd Miller, MD
Purpose This study was intended to evaluate the efficacy of image guided epidural steroid injections in a population of patients presenting to the Emergency Department (ED) with acute low back pain.  These patients failed initial medical management in the ED with intravenous opioids and injected NSAIDs.  They were being considered for admission for pain control. Materials & Methods This was an IRB approved and HIPAA compliant retrospective review of two patient cohorts.  The treatment group consisted of 34 patients (16 Female and 20 male) age 47 (SD 12) with acute low back pain.  Average reported pain on a numerical rating scale (NRS) was 8.8 (SD 1.5).  Average duration of symptoms was 7 weeks (SD 11.4).  Pain unresponsive to hydromorphone and ketodolac in the ED.  The control group was an age-matched group of 25 females and 24 males.  Average reported pain on NRS was 9.2 (SD 1.5).  Average reported pain duration was 2.5 weeks (SD 6.5).  The treatment group received an image guided epidural steroid injection during the ED visit. The control group was admitted for medical pain control.  Length of stay, medication usage, admission statistics, and pain report was reviewed. Results No members of the treatment group required hospital admission.  Reported pain after injection was 0.33 (SD 0.6).  Total ED length of stay for the treatment group was 8 hours vs. 13 hours for the control group.  All control group patients were admitted to the hospital with an average hospital length of stay of 7 days.  The control group required between 2.5 and 10 times the hydromorphone in the ED as the intervention group and between 1.5 and 5 times the morphine.  Upon discharge from the hospital admission, the control group required 10 times the number of oxycodone prescriptions and 28 times the number of hydromorphone prescriptions. Conclusion Epidural steroids are a safe and effective means of providing pain relief for an ED population presenting with acute severe low back pain.  This treatment prevents lengthy hospital admission, reduces overall ED length of stay, and results in a marked decrease in requirements for narcotic pain medicaiton in the ED and after discharge. References Shepherd, T. M., Hess, C. P., Chin, C. T., Gould, R., & Dillon, W. P. (2011). Reducing Patient Radiation Dose during CT-Guided Procedures: Demonstration in Spinal Injections for Pain. American Journal of Neuroradiology. doi:10.3174/ajnr.A2634 Karppinen, J., Malmivaara, A., Kurunlahti, M., Kyllönen, E., Pienimäki, T., Nieminen, P., Ohinmaa, A., et al. (2001). Periradicular infiltration for sciatica: a randomized controlled trial. Spine, 26(9), 1059–1067. Carette, S., Leclaire, R., Marcoux, S., Morin, F., Blaise, G. A., St-Pierre, A., Truchon, R., et al. (1997). Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. New England Journal of Medicine, 336(23), 1634–1640. doi:10.1056/NEJM199706053362303