Open AccessSystematic Review of the Effectiveness of Cervical Epidurals in the Management of Chronic Neck Pain
Author(s) -
Ramsin Benyamin
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/137
Subject(s) - medicine , neck pain , interventional pain management , systematic review , observational study , physical therapy , psychological intervention , chronic pain , manual therapy , evidence based medicine , population , medline , health care , alternative medicine , pathology , political science , law , environmental health , psychiatry , economic growth , economics
Background: Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%, and 14% of the patients reporting grade II to IVneck pain with high pain intensity and disability that has a substantial impact on health careand society.Cervical epidural injections for managing chronic neck pain are one of the commonly performed interventions in the United States. However, the literature supporting cervical epiduralsteroids in managing chronic pain problems has been scant and no systematic review dedicated to the evaluation of cervical interlaminar epidurals has been performed in the past.Study Design: A systematic review of cervical interlaminar epidural injections.Objective: To evaluate the effect of cervical interlaminar epidural injections in managing various types of chronic neck and upper extremity pain emanating as a result of cervical spine pathology.Methods: The available literature of cervical interlaminar epidural injections in managingchronic neck and upper extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized forinterventional techniques for randomized trials and the criteria developed by the Agency forHealthcare Research and Quality (AHRQ) criteria for observational studies.The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions.Data sources included relevant literature of the English language identified through searchesof PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles.Outcome Measures: The primary outcome measure was pain relief (short-term relief = upto 6 months and long-term > 6 months). Secondary outcome measures were improvement infunctional status, psychological status, return to work, and reduction in opioid intake.Results: The indicated evidence is Level II-1 in managing chronic neck and upper extremity pain.Limitations: The limitations of this systematic review include the paucity of literature andlack of randomized trials performed under fluoroscopy.Conclusion: The results of this systematic evaluation of cervical interlaminar epidural injection showed significant effect in relieving chronic intractable pain of cervical origin and alsoproviding long-term relief with an indicated evidence level of Level II-1.Key words: Cervical disc herniation, cervical post surgery syndrome, cervical spinal stenosis, cervical radiculitis, cervical interlaminar epidural injections, local anesthetic steroids, chronic discogenic pain