A Comparison of the Interlaminar v. the Transforaminal Approach To Steroid Injections under Fluoroscopic Control in Treating Lumbar Radicular Pain

Background and Purpose: Lateral lumbar spinal compression is a common source of lower back and leg pain. Steroids injected around the dura-sac markedly decrease inflammation commonly associated with conditions such as, disc-herniation or s. This study’s goal was to prove how epidural injections of steroids, transforaminal or interlaminar, lead to improved pain reduction. Materials and Methods: 50 patients were included in the study by random choice. They were stratified with magnetic resonance imaging and mlectromyography, according to their confirmed diagnosis of lumbar lateral spinal compression. The selected patients were divided into two groups according to reception-path of epidural steroids. In both groups 25 patients were selected by random choice to receive interlaminar or transforaminal epidural steroid injections, in both cases under fluoroscopic guidance. The patients were monitored and their pain assessed by using the visual analogue scale (0–10) during each visit, and during the visits three and six months following the first injection (using VAS scores). Results and conclusions: After the first and second injection of steroids an efficient decrease of pain was evident, although a tendency towards further decrease was not continued after the third injection of steroids and local anaesthesia. The tendency towards decreasing and maintaining the level of pain was recorded as the same both with the interlaminar and the transforaminal approach to steroid injections. The difference in assessed pain between the group with the transforaminal approach and the group with the interlaminar approach did not appear significant in our study. The results of our research have demonstrated that there is no difference in the efficacy of the epidural steroid injection regarding its approach; that is the efficacy is at the same level both with the interlaminar approach as with the transforaminal approach

PLACEBO IN THE PAIN TREATMENT

Uporaba farmakološki neaktivnih tvari ili postupaka poznatih kao ’placebo’ uvriježena je u medicinskim krugovima pri ispitivanju lijekova. Njihova primjena ima veliku važnost u kontroliranim kliničkim studijama liječenja boli i u istraživanjima mehanizama prijenosa bolnih podražaja. Novije studije pokazale su da je učinak placeba mjerljiv, praćen promjenama moždane aktivnosti i odgovarajućega subjektivnog doživljaja intenziteta boli. U ovom članku opisane su promjene koje se događaju kod placebne analgezije, intenzitet smanjenja boli u usporedbi s aktivnim lijekovima te osnovni problemi pri primjeni placeba u kliničkoj praksi i istraživanjima.Use of medical preparations having no specific pharmacological activity or dummy procedures administered to patients is known as placebo. Such maneuvers are important in the pain treatment and clinical studies investigating pain mechanisms. Several recent studies have shown that placebo treatment produces measurable psychophysiological effects, characterized by changes in specific brain functions and decreased subjective pain perception. This article reviews changes observed in placebo analgesia, its intensity as compared to active compounds, and principal problems observed during the placebo treatment and in clinical trials