From the Guidelines
For patients experiencing post-epidural persistent back pain, clinicians should provide evidence-based information on the expected course, advise patients to remain active, and provide information about effective self-care options, including the use of medications with proven benefits such as acetaminophen or nonsteroidal anti-inflammatory drugs 1. When managing post-epidural back pain, it is essential to conduct a focused history and physical examination to categorize the pain into nonspecific back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause 1.
Key Considerations
- The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain 1.
- Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain, unless severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination 1.
- For patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis, magnetic resonance imaging (preferred) or computed tomography should be considered only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) 1.
Management Strategies
- Provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options 1.
- Consider the use of medications with proven benefits in conjunction with back care information and self-care, such as acetaminophen or nonsteroidal anti-inflammatory drugs 1.
- Assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
From the Research
Post Epidural Persistent Back Pain
- Post epidural persistent back pain can be a challenging condition to manage, with various treatment options available 2, 3, 4, 5, 6.
- The evaluation and management of chronic low back pain, including post epidural persistent back pain, involve a thorough history and physical examination to identify red flags and yellow flags 2, 6.
- Treatment options for post epidural persistent back pain may include:
- Nonpharmacologic interventions such as counseling, exercise therapy, spinal manipulation, massage, heat, dry needling, acupuncture, transcutaneous electrical nerve stimulation, and physical therapy 2, 3, 6.
- Pharmacologic interventions such as nonsteroidal anti-inflammatory drugs, duloxetine, and other medications 2, 5, 6.
- Epidural corticosteroid injections may be considered for short-term symptom relief in patients with radicular pain 2, 3, 6.
- Studies have shown that epidural steroid injections and physical therapy can be effective in improving pain and functional parameters in patients with lumbar spinal stenosis and lumbar radiculopathy 3, 5.
- The choice of treatment for post epidural persistent back pain should be individualized based on the patient's specific condition, medical history, and response to previous treatments 2, 6.