Bel ağrılı hastalarda transforaminal anterior epidural steroid enjeksiyonunun etkinliğinin ve girişimsel tedavinin yaşam kalitesine etkisinin retrospektif araştırılması
Amaç: Bel ağrısı şikayeti ile başvuran hastalarda uygulanan transforaminal anterior epidural steroid ve lokal anestezik enjeksiyonlarının (TAESE) etkinliğini ve yaşam kalitesindeki değişiklikleri retrospektif olarak incelemektir. Gereç ve Yöntem: Çalışmaya dahil edilen (191) hasta; lomber disk hernisi (DH), başarısız bel cerrahisi (BBC) ve spinal stenoz (SS) olarak 3 gruba ayrıldı. Hastaların ağrısının değerlendirilmesinde görsel analog skala (visual analogue scale) (VAS) ve sözel ağrı skalası (SAS) kullanıldı. Hastaların ağrı ölçümleri, tedavi öncesi (VAS 0), uygulamanın 1. ayında (VAS 1), 3. ayında (VAS 3) ve 6.ayında (VAS 6) yapıldı. Hastaların yaşam kalitesi, Tıbbi Hastalıklar Sonlanım Çalışması (Medical Outcome Study, MOS) Short Form 36 (SF-36) ile sorgulandı. Bulgular: Her 3 grupta da hastaların ağrı seviyelerinde girişim öncesine (VAS 0) göre 1, 3 ve 6. aylarda istatistiksel olarak belirgin azalma saptandı (p
A retrospective investigation of the efficiency of transforaminal anterior epidural steroid injections in patients with low back pain and the effects of interventional pain therapy on quality of life
Objectives: The aim of this retrospective study was to evaluate the efficacy of transforaminal anterior epidural steroid and local anesthetic injections (TAESE) and the effects on quality of life in patients with low back pain. Methods: The study patients (n=191) were divided into 3 groups: disc herniation (DH), failed back surgery (FBS), and spinal stenosis (SS). A visual analog scale (VAS) and verbal pain scale (VPS) were used to assess patient pain. Scores were measured before treatment (VAS 0), in the first month of application (VAS 1), 3 months (VAS 3), and 6 months (VAS 6). Patient quality of life was examined using the 36-Item Short Form Health Survey (SF-36). Results: In all 3 groups, there was a statistically significant reduction in pain compared with the VAS 0 score at 1, 3, and 6 months (p
___
- Reilly PA. Occupational low back pain. J Rheumatol
2001;28(2):225–6.
- Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit
rates: estimates from U.S. national surveys, 2002. Spine
(Phila Pa 1976) 2006;31(23):2724–7. [CrossRef]
- Saal JA, Saal JS. Nonoperative treatment of herniated lumbar
intervertebral disc with radiculopathy. An outcome
study. Spine (Phila Pa 1976) 1989;14(4):431–7. [CrossRef]
- Manchikanti L, Datta S, Gupta S, Munglani R, Bryce DA,
Ward SP, et al. A critical review of the American Pain Society
clinical practice guidelines for interventional techniques:
part 2. Therapeutic interventions. Pain Physician
2010;13(4):E215–64.
- McLain RF, Kapural L, Mekhail NA. Epidural steroid therapy
for back and leg pain: mechanisms of action and efficacy.
Spine J 2005;5(2):191–201. [CrossRef]
- Manchikanti L, Cash KA, Pampati V, Falco FJ. Transforaminal
epidural injections in chronic lumbar disc herniatio: a randomized,
double-blind, active-control trial. Pain Physician
2014;17(4):E489–501.
- Manchikanti L, Singh V, Pampati V, Falco FJ, Hirsch JA. Comparison
of the efficacy of caudal, interlaminar, and transforaminal
epidural injections in managing lumbar disc herniation:
is one method superior to the other? Korean J Pain
2015;28(1):11–21. [CrossRef]
- Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP.
Epidural steroids: a comprehensive, evidence-based review.
Reg Anesth Pain Med 2013;38(3):175–200. [CrossRef]
- Manchikanti L. Transforaminal lumbar epidural steroid injections.
Pain Physician 2000;3(4):374–98.
- Williamson A, Hoggart B. Pain: a review of three commonly
used pain rating scales. J Clin Nurs 2005;14(7):798–804.
- Kocyiğit H, Aydemir O, Fişek G, Ölmez N, Memiş A. Kısa
form-36’nın Türkçe versiyonunun güvenilirliği ve geçerliliği.
İlaç ve Tedavi Dergisi 1999;12:102–6.
- Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli
JT, Freeman ED, et al. Fluoroscopically guided lumbar
transformational epidural steroid injections in degenerative
lumbar stenosis: an outcome study. Am J Phys Med
Rehabil 2002;81(12):898–905. [CrossRef]
- Lee JW, Kim SH, Lee IS, Choi JA, Choi JY, Hong SH, et al. Therapeutic
effect and outcome predictors of sciatica treated
using transforaminal epidural steroid injection. AJR Am J
Roentgenol 2006;187(6):1427–31. [CrossRef]
- Latza U, Kohlmann T, Deck R, Raspe H. Can health care utilization
explain the association between socioeconomic status
and back pain? Spine (Phila Pa 1976) 2004;29(14):1561–
6. [CrossRef]
- Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain:
prevalence and associated risk factors among hospital
staff. J Adv Nurs 2009;65(3):516–24. [CrossRef]
- Ostgaard HC, Andersson GB. Previous back pain and risk of
developing back pain in a future pregnancy. Spine (Phila
Pa 1976) 1991;16(4):432–6. [CrossRef]
- Çevik R, Gür A, Nas K, Kaptan H, Em S, Can AR, et al. Evaluation
of 350 patients with chronic low back pain. Ege Fiz Tıp
Reh Der 2001;7(3-4):97–103.
- Yılmaz E. Özkan S. Hastanede Çalışan Hemşirelerde Bel
Ağrısı Sıklığının Saptanması. Türk Fiz Tıp Rehab Derg
2008;54:8–12.
- Yazıcı K, Tot Ş, Bicer A, Yazıcı A, Buturak V. Bel ve boyun ağrısı
hastalarında anksiyete, depresyon ve yaşam kalitesi.
Klinik Psikiyatri Dergisi 2003;6:95–101.
- Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness
of transforaminal epidural steroid injection by
using a preganglionic approach: a prospective randomized
controlled study. Radiology 2007;245(2):584–90.
- Parr AT, Manchikanti L, Hameed H, Conn A, Manchikanti
KN, Benyamin RM, et al. Caudal epidural injections in the
management of chronic low back pain: a systematic appraisal
of the literature. Pain Physician 2012;15(3):E159–98.
- Ketenci A. Kronik mekanik bel ağrısı bir hastalık mıdır? Fiziksel
Tıp ve Rehabilitasyon Dergisi 1998;44(5).
23. Erdine S. Ağrı. 3rd ed. İstanbul: Nobel Tıp Kitabevleri; 2007.
p. 423.
- Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL,
et al. Epidural steroids in the management of chronic spinal
pain: a systematic review. Pain Physician 2007;10(1):185–
212.
- Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal
injection of steroids for the treatment of lumbar
radicular pain. Pain Med 2010;11(8):1149–68. [CrossRef]
- Zhai J, Zhang L, Li M, Tian Y, Zheng W, Chen J, et al. Epidural
injection with or without steroid in managing chronic
low back and lower extremity pain: ameta-analysis
of ten randomized controlled trials. Int J Clin Exp Med
2015;8(6):8304–16.
- Kennedy DJ, Plastaras C, Casey E, Visco CJ, Rittenberg JD,
Conrad B, et al. Comparative effectiveness of lumbar transforaminal
epidural steroid injections with particulate versus
nonparticulate corticosteroids for lumbar radicular
pain due to intervertebral disc herniation: a prospective,
randomized, double-blind trial. Pain Med 2014;15(4):548–
55. [CrossRef]
- Ergin A. Epidural steroid injections and low back pain. Agri
2005;17(1):23–7.
- Raffo C, Wiesel S, Lauerman W. Determining reasons for
failed lumbar spine surgery. The Adult Spine. LippincottRaven
2003;945–54.
- Schofferman J, Reynolds J, Herzog R, Covington E, Dreyfuss
P, O’Neill C. Failed back surgery: etiology and diagnostic
evaluation. Spine J 2003;3(5):400–3. [CrossRef]
- Lin CW, McAuley JH, Macedo L, Barnett DC, Smeets RJ, Verbunt
JA. Relationship between physical activity and disability
in low back pain: a systematic review and meta-analysis.
Pain 2011;152(3):607–13. [CrossRef]
- Ehrlich GE. Low back pain. Bull World Health Organ
2003;81(9):671–6.
- Özdinç SA, Kokino S, Hakgüder A, Gezici B, Turan F. Farklı
bölge kas iskelet sistemi hastalıklarında yaşam kalitesinin
karşılaştırılması. Fizyoter Rehabil 2008;19(3):123–8.
- Bhatti AB, Kim S. Role of Epidural Injections to Prevent Surgical
Intervention in Patients with Chronic Sciatica: A Systematic
Review and Meta-Analysis. Cureus 2016;8(8):e723.
- Abdi S, Datta S, Lucas LF. Role of epidural steroids in the
management of chronic spinal pain: a systematic review
of effectiveness and complications. Pain Physician
2005;8(1):127–43.
- Ryan RM, Frederick C. On energy, personality, and health:
subjective vitality as a dynamic reflection of well-being. J
Pers 1997;65(3):529–65. [CrossRef]
- Borg C, Hallberg IR, Blomqvist K. Life satisfaction among
older people (65+) with reduced self-care capacity: the
relationship to social, health and financial aspects. J Clin
Nurs 2006;15(5):607–18. [CrossRef]
- Ryan RM, Deci EL. On happiness and human potentials: a
review of research on hedonic and eudaimonic well-being.
Annu Rev Psychol 2001;52:141–66. [CrossRef]