Evaluation of the Effectiveness of Transforaminal Epidural Injections in Lumbar Disc Herniation or Radiculitis - Full Text View

Purpose

To evaluate differences in outcomes in patients receiving steroids compared to those patients randomized to the local anesthetic group who did not receive steroids.

To evaluate and compare the adverse event profile in all patients.

Condition	Intervention
Low Back Pain	Drug: lumbar transforaminal epidural injections

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver) Primary Purpose: Treatment
Official Title:	A Randomized, Prospective, Double-Blind, Equivalence, Controlled Evaluation of the Effectiveness of Transforaminal Epidural Injections in Lumbar Disc Herniation or Radiculitis With or Without Steroids

Resource links provided by NLM:

MedlinePlus related topics: Back Pain Hernia

Drug Information available for: Lidocaine hydrochloride Lidocaine Bupivacaine hydrochloride Bupivacaine

U.S. FDA Resources

Further study details as provided by Pain Management Center of Paducah:

Primary Outcome Measures:

Numeric rating scale (NRS), Oswestry Disability Index (ODI), duration of significant pain relief, opioid intake, and return to work [ Time Frame: Outcomes are measured at baseline and at 3, 6, 12, 18, and 24 months post-treatment. ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Adverse event profile of side effects and complications. [ Time Frame: Adverse events are measured at baseline and at 3, 6, 12, 18, and 24 months post-treatment, and at any time during the procedure or after the procedure the adverse events are suspected or expected. ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	120
Study Start Date:	February 2010
Estimated Study Completion Date:	January 2014
Primary Completion Date:	January 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Without Steroids Group I patients receiving lumbar transforaminal epidural injections with an injection of local anesthetic (lidocaine 1% or bupivacaine 0.25%	Drug: lumbar transforaminal epidural injections with an injection of local anesthetic or with 1% lidocaine or 0.25% bupivacaine with 3 mg of steroid per level Other Name: 1% Xylocaine, 0.25% bupivacaine, non-particulate Celestone.
Active Comparator: steroids Group II patients will receive transforaminal epidural injections with 1% lidocaine or 0.25% bupivacaine with 3 mg of steroid per level	Drug: lumbar transforaminal epidural injections with an injection of local anesthetic or with 1% lidocaine or 0.25% bupivacaine with 3 mg of steroid per level Other Name: 1% Xylocaine, 0.25% bupivacaine, non-particulate Celestone.

Detailed Description:

Recruitment is indicated in patients with chronic low back and lower extremity pain secondary to lumbar disc herniation and/or lumbar radiculitis of at least 6-months duration, non-responsive to conservative management with NSAIDs, physical therapy, chiropractic treatment, and exercises.

This is a single center study performed in an interventional pain management referral center in the United States.

The study involves 120 patients studied in 2 groups with 60 patients in each group. Randomization includes sequence generation, allocation concealment, implementation, and blinding.

Data management analysis includes sample size justification of 40 patients in each group with a power of 80% and a 0.05% 2-sided significance level. Statistical methodology includes chi-squared statistics, Fisher's exact test, t-test, and paired t-test with significance evaluated at P value < 0.05.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion criteria:

Patients with disc herniation or radiculitis
Patients who are 18 years of age
Patients with a history of chronic function-limiting low back and lower extremity pain of at least 6 months duration
Patients who are competent to understand the study protocol and provide voluntary, written informed consent and participate in outcome measurements

Exclusion criteria:

Previous lumbar surgery, radiculitis secondary to spinal stenosis without disc herniation
Uncontrollable or unstable opioid use
Uncontrolled psychiatric disorders
Uncontrolled medical illness either acute or chronic
Any conditions that could interfere with the interpretation of the outcome assessments
Pregnant or lactating women

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01052571

Locations

United States, Kentucky
Ambulatory Surgery Center
Paducah, Kentucky, United States, 42001

Sponsors and Collaborators

Pain Management Center of Paducah

Investigators

Principal Investigator:

Laxmaiah Manchikanti, MD

Ambulatory Surgery Center, Paducah

More Information

No publications provided

Responsible Party:	Laxmaiah Manchikanti, MD, Medical Director, Pain Management Center of Paducah
ClinicalTrials.gov Identifier:	NCT01052571 History of Changes
Other Study ID Numbers:	Protocol 24
Study First Received:	January 18, 2010
Last Updated:	March 21, 2012
Health Authority:	United States: Institutional Review Board

Keywords provided by Pain Management Center of Paducah:

Chronic low back pain
Lumbar disc herniation
Lower extremity pain
Lumbar radiculitis

Local anesthetic
Steroid
Lumbar transforaminal epidural injection

Additional relevant MeSH terms:

Back Pain
Hernia
Low Back Pain
Radiculopathy
Intervertebral Disk Displacement
Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Pathological Conditions, Anatomical
Peripheral Nervous System Diseases
Neuromuscular Diseases
Spinal Diseases

Bone Diseases
Musculoskeletal Diseases
Anesthetics, Local
Bupivacaine
Anesthetics
Central Nervous System Depressants
Physiological Effects of Drugs
Pharmacologic Actions
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on May 21, 2013