Subject(s)
Radiculopathy , Humans , Injections, Epidural , Radiculopathy/drug therapy , Steroids/therapeutic useABSTRACT
MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , COVID-19 Vaccines/administration & dosage , COVID-19 , Pain/drug therapy , Vaccines, Synthetic/administration & dosage , Humans , Time Factors , mRNA VaccinesABSTRACT
MYTH: Genicular nerve radiofrequency ablation (RFA) is not associated with known clinically significant complications. FACT: Although genicular nerve RFA is generally considered a safe procedure, cases of septic arthritis, pes anserine tendon injury, third-degree skin burn, and clinically significant hematoma and/or hemarthrosis have been reported. As with any emerging procedure, other yet-to-be-reported complications are possible.
Subject(s)
Catheter Ablation , Osteoarthritis, Knee , Radiofrequency Ablation , Humans , Knee , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Radiofrequency Ablation/adverse effectsABSTRACT
OBJECTIVE: To determine the effectiveness of lumbar transforaminal injection of steroid for the treatment of radicular pain. DESIGN: Comprehensive systematic review. OUTCOME MEASURES: The primary outcome of interest was the proportion of individuals with reduction of pain by ≥50%. Additional outcomes of interest were a more-than-two-point reduction in pain score, patient satisfaction, functional improvement, decreased use of pain medication, and avoidance of spinal surgery. RESULTS: For patients with disc herniations, using the criterion of ≥50% reduction in pain, success rates across included studies (range) were 63% (58-68%) at one month, 74% (68-80%) at three months, 64% (59-69%) at six months, and 64% (57-71%) at one year. For patients with lumbar spinal stenosis, success rates across included studies (range) were 49% (43-55%) at one month, 48% (35-61%) at three months, 43% (33-53%) at six months, and 59% (45-73%) at one year, but there was a lack of corroboration from appropriately controlled studies. CONCLUSIONS: There is strong evidence that lumbar transforaminal injection of steroids is an effective treatment for radicular pain due to disc herniation. There is a lack of high-quality evidence demonstrating their effectiveness for the treatment of radicular pain due to spinal stenosis, though small studies suggest a possible benefit. Lumbar transforaminal injection of nonparticulate steroids is as effective as injections with particulate steroids.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Intervertebral Disc Displacement/drug therapy , Neuralgia/drug therapy , Spinal Stenosis/drug therapy , Female , Humans , Injections, Epidural , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Male , Neuralgia/etiology , Radiculopathy/drug therapy , Radiculopathy/etiology , Spinal Stenosis/complicationsSubject(s)
Drug Contamination/prevention & control , Drug Packaging , Equipment Failure , Equipment Safety , Glass , Humans , Injections , Needles , RubberABSTRACT
OBJECTIVE: To determine if skin wheals reduce procedural pain associated with lumbar medial branch blocks (MBBs) performed with 25-gauge needles. DESIGN: Prospective comparative observational study. SETTING: Outpatient Physical Medicine & Rehabilitation and interventional pain practice within an academic tertiary care center. SUBJECTS: Ninety-nine consecutive patients who underwent lumbar MBBs for facet pain were included. Patients who were obese or required larger-diameter needles were excluded. METHODS: One to three facet joints were targeted per side, with some patients receiving bilateral procedures. All injections were performed with 25-gauge, 3.5-inch Quincke tip needles under fluoroscopic guidance. A total of 306 needle sticks were recorded. MBBs were performed without skin wheals or any other type of local anesthesia (35 patients, 108 needle sticks), with skin wheals (30 patients, 94 needle sticks), and in mixed groups (34 patients, 47 needle sticks with skin wheals, 57 needle sticks without skin wheals or other type of local anesthesia). Patients rated the pain of each needle placement immediately after the multilevel MBB procedure. RESULTS: Considering all 306 needle sticks, needles that were placed using skin wheals caused slightly more pain than those placed without skin wheals or any other type of local anesthesia (P = 0.007). CONCLUSIONS: Skin wheals do not reduce and may increase procedural pain associated with lumbar MBBs performed with 25-gauge needles.
Subject(s)
Anesthetics, Local/administration & dosage , Nerve Block/adverse effects , Pain, Procedural , Aged , Female , Humans , Low Back Pain/diagnosis , Lumbosacral Region , Male , Needles , Nerve Block/instrumentation , Nerve Block/methods , Zygapophyseal JointSubject(s)
Contrast Media , Gadolinium , Injections, Spinal/methods , Iodine , Fluoroscopy , Humans , Surgery, Computer-Assisted/methodsABSTRACT
Objective: To determine the risks of continuing or ceasing anticoagulant or antiplatelet medications prior to image-guided procedures for spine pain. Design: Systematic review of the literature with comprehensive analysis of the published data. Interventions: Following a search of the literature for studies pertaining to spine pain interventions in patients on anticoagulant medication, seven reviewers appraised the studies identified and assessed the quality of evidence presented. Outcome Measures: Evidence was sought regarding risks associated with either continuing or ceasing anticoagulant and antiplatelet medication in patients having image-guided interventional spine procedures. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation system. Results: From a source of 120 potentially relevant articles, 14 provided applicable evidence. Procedures involving interlaminar access carry a nonzero risk of hemorrhagic complications, regardless of whether anticoagulants are ceased or continued. For other procedures, hemorrhagic complications have not been reported, and case series indicate that they are safe when performed in patients who continue anticoagulants. Three articles reported the adverse effects of ceasing anticoagulants, with serious consequences, including death. Conclusions: Other than for interlaminar procedures, the evidence does not support the view that anticoagulant and antiplatelet medication must be ceased before image-guided spine pain procedures. Meanwhile, the evidence shows that ceasing anticoagulants carries a risk of serious consequences, including death. Guidelines on the use of anticoagulants should reflect these opposing bodies of evidence.
