EPIDURAL STEROID INJECTION AND AMITRIPTYLINE IN THE MANAGEMENT OF ACUTE LOW BACK PAIN ORIGINATING FROM LUMBAR DISC HERNIATION
Lütfiye PİRBUDAK1, Günhan KARAKURUM2, Tolgay ŞATANA3, Hakan KARADAŞLI1, Melihşah TOPALHAN2, Ünsal ÖNER1, Akif GÜLEÇ2
1Gaziantep Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı
2Gaziantep Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı
3Gaziantep Amerikan Hastanesi
Keywords: Pain of Disk Origin, Epidural Steroid İnjection, Amitryptilin, Back Pain.
Introduction: Herniation of the vertebral disc is an important cause of back pain. This study was designed to compare the effectiveness of epidural steroid injection (EPSI) with EPSI plus amitryptilin in the patients who had back pain due to disc herniation. Material and
Methods: Sixty patients who had acute discogenic back pain with unilateral sciatic ache were included in the study The patients were randomly divided into two groups. Single dose of a mixture with epidural steroid (benzylprednizolon 14 mg) and local anesthetic (bupivakain %0.25) was administered to all patients. In addition to that, the patients in Group II were also treated with amitryptilin (10-50 mg p.o.) for 6 months while placebo was given to Group I. The effective ness of the treatment was evaluated with visual analoge scale (VAS), straight leg raising test (SLR; 0° is worst, 85° is best) and Oswestry Low Back Pain Disability Index (ODI).
Results: At the second week of treatment, a significant improvement was seen in VAS, SLR and ODI scores in both Groups. In Group II, the time of onset of analgesia was shorter while the need for repeated injections was less. According to ODI, the quality of life was better in Group II from 6 months on (p=0.02, t=-2.320). It was observed that the treatment was efficious in both groups at the end of 6 moths.
Conclusion: Although both EPSI and EPSI plus amitryptiline have similar effects in acute back pain of disc origion, the latter appears to be more advantageous in terms of quality of life.