Comparison of the Effect of Caudal Epidural and Trigger Point Steroid Injections on Pain Control in Patients with Chronic Low Back Pain

Mahshid  Ghasemi; Maryam  Nasoohi; Amir  Bisadi; Faranak  Behnaz

doi:10.18502/aacc.v11i5.19927

Mahshid Ghasemi Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Maryam Nasoohi Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Amir Bisadi Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Faranak Behnaz Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v11i5.19927

Keywords: Low back pain; Caudal epidural; Pain management; Trigger points

Abstract

Background: Chronic spinal pain can be managed through various approaches, including surgical options and interventional techniques like epidural injections and trigger point injections. However, there is a notable lack of comparative research addressing the effectiveness of these two specific methods in alleviating chronic low back pain. This study aimed to evaluate and compare the pain relief outcomes associated with caudal epidural steroid injections and trigger point steroid injections in patients suffering from chronic low back pain.

Methods: Sixty patients aged between 20 and 75 years, who had been dealing with chronic low back pain for more than 12 weeks and had a Visual Analog Scale (VAS) score exceeding three, were randomly assigned into two groups of thirty. One group received caudal epidural injections, while the other group was treated with trigger point injections. In the caudal epidural group, a mixture of corticosteroid and 2 mg of ropivacaine was administered under ultrasound guidance at the caudal epidural site. Similarly, the trigger point injection group received the same dosage of corticosteroid and local anesthetic, injected into the identified trigger points under ultrasound guidance. Participants were monitored for six weeks after the injections, with pain levels evaluated at weeks 2, 4, and 6 using the VAS. A two-way ANOVA analysis was conducted to identify differences in pain relief between the two groups.

Results: The findings showed significant differences in pain levels between the two groups. Patients who received caudal epidural injections reported a more substantial reduction in pain compared to those who received trigger point injections. Additionally, the caudal epidural group exhibited a continuous decrease in pain levels at the follow-up assessments from weeks 2 to 6.

Conclusion: This study indicates that caudal epidural steroid injections are a safe and effective method for managing and reducing chronic low back pain. Given these results, caudal epidural injections should be considered a viable treatment option for patients experiencing chronic low back pain.