Presented at the 2013 AAPM Annual Meeting « Back

Pressure Paresthesia Occurring During Interlaminar Lumbar Epidural Steroid Injections Correlates with Pain Relief

Nebojsa Nick Knezevic, MD PhD, nick.knezevic@gmail.com¹, Kenneth D. Candido, MD², Maunak Rana, MD², Jonathan R. Kamerlink, MD², Lalida Chupatanakul, MD³, Ruben Sauer, MD³, (1) University of Illinois, Chicago, Illinois, (2) Advocate Illinois Masonic Medical Center, Chicago, Illinois, (3) Chicago Anesthesia Pain Specialists, Chicago, Illinois

Introduction: The purpose of this study was to compare two different approaches during interlaminar LESI and assess correlation between pressure paresthesia occurring during the LESI and pain relief. Material/Methods: After IRB approval, 100 patients undergoing LESI for radicular low back pain were randomly assigned to one of two groups (50 patients each) based on approach: midline (MIL) and parasagittal interlaminar (PIL). Patients were asked to grade a pressure paresthesia from 0 to 3 ispilaterally and contralaterally, and confirm whether the pressure paresthesia was in distribution of "usual and customary pain" or distinct from "usual and customary pain". The Oswestry Low Back Pain questionnaire and pain scores at rest and during movement were recording 20 minute before procedure and on days 1, 7, 14, 21 and 28 after the injection. Results: LESI clinically and statistically significantly reduced lumbosacral radiculopathic pain at rest and during movement (Figure 1a,b). Both groups showed improvement in their everyday activities and quality of life (Figure 1c). However, patients in PIL group described significantly higher rates of concordant moderate-to-severe pressure paresthesia compared to the MIL group (Table 1). Our results also showed correlation between pressure paresthesia occurring during the LESI in the same distribution as the radicular pain with the pain relief. Conclusions: Both LESI approaches were effective in reducing pain and improving quality of life. Concordant pressure paresthesia occurring during the LESI could be used as an indicator of proper achievement of medication target, thus increasing the likelihood of an improved outcome toward pain resolution.

Funding: None

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