Epidural
steroid injections are the most commonly used procedures to manage chronic
low back pain in interventional
pain management settings. Approaches available to access the epidural space in the lumbosacral spine include the interlaminar, transforaminal, and caudal. The overall effectiveness of epidural
steroid injections has been highly variable. This study included 65 patients who underwent diagnostic facet joint
nerve blocks utilizing comparative
local anesthetic blocks and were shown to be negative for facet joint
pain and other problems such as sacroiliac joint
pain before enrollment into the study. They were randomly selected from 105 patients negative for facet joint
pain allocated into three groups, with Group I consisting of 15 patients comprising a convenience control sample treated conservatively; Group II, consisting of 22 patients treated with caudal epidural with
local anesthetic and
Sarapin(R); and Group III, consisting of 33 patients treated with caudal epidural with a mixture of
local anesthetic, and
betamethasone. The study period lasted for 3 years. Results showed that there was significant improvement in patients receiving caudal
epidural injections, with a decrease in
pain associated with improved physical, functional and mental status; and decreased
narcotic intake combined with return to work. The study showed that at 1 month 96% of the patients evaluated showed significant improvement, which declined to 56% at 3 months and 16% at 6 months, with administration of 1 to 3
injections. Cumulative relief with 1 to 12
injections was noted in 96% of the patients at 1 month, 95% at 3 months, 85% at 6 months, and 67% at 1 year. The study also showed cost effectiveness of this treatment, with a cost of $ 2550 for 1-year improvement of quality of life . In conclusion, caudal
epidural injections with
steroids or
Sarapin are an effective modality of treatment in managing chronic, persistent
low back pain that fails to respond to conservative modalities of treatments and is also negative for facet joint
pain. The treatment is not only effective clinically but also is cost effective.