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Transforaminal Steroid Shot Benefits Lumbar Radicular Pain

Appears to be viable alternative to surgery; more than half of patients have pain relief at one month

FRIDAY, July 30 (HealthDay News) -- Transforaminal injection of steroids appears to be a viable alternative to surgery for some patients with lumbar radicular pain caused by disc herniation, according to a study published online July 30 in Pain Medicine.

In a prospective, randomized study, Ali Ghahreman, of John Hunter Hospital in Newcastle, Australia, and colleagues compared the outcomes of transforaminal injection of steroid and local anesthetic, local anesthetic alone, or normal saline, and intramuscular injection of steroid or normal saline among 150 patients. The patients had pain radiating into the lower limb, limitation of straight-leg-raise to less than 30 degrees, and disc herniation demonstrated by computed tomography or magnetic resonance imaging.

The researchers found that a significantly greater proportion (54 percent) of patients treated with transforaminal injection of steroid achieved pain relief at one month compared to those who received transforaminal injection of local anesthetic alone (7 percent), transforaminal injection of saline (19 percent), intramuscular steroids (21 percent), or intramuscular saline (13 percent). In addition, outcomes were equivalent for patients with acute or chronic radicular pain. However, the number of patients who maintained pain relief decreased over time, with only some maintaining pain relief beyond one year; and, the proportions of patients maintaining relief beyond one year were not significantly different between the groups.

"In the end, this landmark study has vindicated transforaminal steroid injection for lumbar radicular pain as superior to placebo," writes the author of an accompanying editorial. "Further studies are now needed to determine the durability of the effect of repeated injections over time, to compare that with the long-term utility of other treatments (including surgery), and to determine which patients are most likely to benefit from treatment."

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