Do Oral Steroid Dose Packs Predict How Well Epidural Steroid Injections Will Work?



Status:Recruiting
Conditions:Gastrointestinal
Therapuetic Areas:Gastroenterology
Healthy:No
Age Range:18 - Any
Updated:5/5/2018
Start Date:November 2011
End Date:April 2020
Contact:Bert L. Fichman, MD
Phone:(603) 650-7350

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Oral Steroid Dose Pack Used As A Predictor For The Effectiveness Of Epidural Steroid Injections

The purpose of this observational study is to show whether a standard oral steroid dose pack
can be used as a screening tool to assess the effectiveness of a subsequent epidural steroid
injection (ESI). If an oral steroid does not give a patient significant temporary relief of
pain from a herniated lumbar disc then an epidural steroid injection will not either.
Therefore the risk and expense associated from the interventional pain management procedure
for those patients could be avoided and other treatment modalities pursued.


Inclusion Criteria:

- 18 years and older

- Diagnosed by participating physicians during the study enrollment period as having
intervertebral disk herniation and persistent symptoms with or without some
nonoperative treatment for at least 4 weeks

- Radicular pain (below the knee for lower lumbar herniations, into the anterior thigh
for upper lumbar herniations)

- Evidence of nerve-root irritation with a positive nerve-root tension sign (straight
leg raise-positive between 30° and 70°) or a corresponding neurologic deficit
(asymmetrical depressed reflex, decreased sensation in a dermatomal distribution)

- Undergone either MRI or CT scan showing disc herniation (protrusion, extrusion, or
sequestered fragment) at a level and side corresponding to the clinical symptoms

- Patients with multiple herniations can be included if only one of the herniations is
considered symptomatic

- Preenrollment nonprocedural care can include: education/counseling, physical therapy,
chiropractic therapy, anti-inflammatory medications, opioid analgesics, adjuvant
analgesics such as anticonvulsants and antidepressants

Exclusion Criteria:

- Prior lumbar surgery

- Cauda equina syndrome

- Vertebral fractures

- Spine infection or tumor

- Severe motor deficit

- Inflammatory spondyloarthropathy

- Pregnancy

- Cardiac or pulmonary comorbid conditions contraindicating interventional procedures

- Diabetes

- Inability/unwillingness to have spinal injections
We found this trial at
1
site
1 Medical Center Dr
Lebanon, New Hampshire 03756
 (603) 650-5000
Principal Investigator: Bert L. Fichman, MD
Phone: 603-650-7350
Dartmouth Hitchcock Medical Center Dartmouth-Hitchcock is a national leader in patient-centered health care and building...
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