Articles: back-pain.
-
Anesthesia and analgesia · Dec 2002
Risk assessment of hemorrhagic complications associated with nonsteroidal antiinflammatory medications in ambulatory pain clinic patients undergoing epidural steroid injection.
We prospectively studied 1035 individuals undergoing 1214 epidural steroid injections to determine the risk of hemorrhagic complications. A history of bruising or bleeding was present in 176 (15%) patients. A platelet count was assessed in 77 patients before the epidural steroid injection; none was less than 100 x 10(9)/L. Nonsteroidal antiinflammatory drugs (NSAIDs) were reported by 383 (32%) patients, including 34 patients on multiple medications. Aspirin was the most common NSAID and was noted by 158 patients, including 104 patients on 325 mg or less per day. There were no spinal hematomas (major hemorrhagic complications). Blood was noted during needle or catheter placement in 63 (5.2%) patients (minor hemorrhagic complications). NSAIDs did not increase the frequency of minor hemorrhagic complications. However, increased age, needle gauge, needle approach, needle insertion at multiple interspaces, number of needle passes, volume of injectant, and accidental dural puncture were all significant risk factors for minor hemorrhagic complications. There were 42 patients with new neurologic symptoms or worsening of preexisting complaints that persisted more than 24 h after injection; median duration of the symptoms was 3 days (range, 1-20 days). Our results confirm those of previous studies performed in obstetric and surgical populations that document the safety of neuraxial techniques in patients receiving NSAIDs. We conclude that epidural steroid injection is safe in patients receiving aspirin-like antiplatelet medications. Minor worsening of neurologic function may occur after epidural steroid injection and must be differentiated from etiologies requiring intervention. ⋯ Previous studies performed in obstetric and surgical populations have demonstrated that antiplatelet therapy does not increase the risk of spinal hematoma associated with spinal or epidural anesthesia and analgesia. We confirm the safety of epidural steroid injection in patients receiving aspirin-like medications.
-
Selective nerve root blocks are an effective way of diagnosing and treating radicular pain in many patients. Although traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement. This article discusses the indications and technique of selective nerve root blocks in the cervical, thoracic, and lumbar spine, as well as the evidence supporting their use in the treatment of patients with radiculopathy and/or back pain.
-
The literature on diagnostic tests available to the spine clinician for the evaluation of chronic low back pain was reviewed. ⋯ There are inherent limitations in the accuracy of all diagnostic tests. The tests used to diagnose the source of a patient's chronic low back pain require accurate determination of the abolition or reproduction of the patient's painful symptoms.
-
A literature review and synthesis were performed. ⋯ Intraspinal medication delivery has become an effective technique for control of intractable pain in appropriately selected patients seen by spine surgeons.
-
To investigate use of prescribed analgesic drugs in relation to experience of joint or back pain in a home-dwelling older population, to study changes in the use of analgesic drugs over 10 years, and to investigate concomitant use of protective gastrointestinal drugs with prescribed analgesic drugs in 1999. ⋯ Pain is markedly undertreated in community-dwelling older people, which may have serious implications for their well-being and functioning. Although we noted a tendency for safety in the use of prescribed analgesic drugs, a significant effort must sill be made to implement evidence-based practice. Self-treatment of pain has increased in 1 decade, which may reduce the overall safety of analgesic drug use among older people.