Evaluation of Gabapentin and Transforaminal Corticosteroid Injections for Brachioradial Pruritus.
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SUBMITTER: Gutierrez RA
PROVIDER: S-EPMC9280609 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
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Evaluation of Gabapentin and Transforaminal Corticosteroid Injections for Brachioradial Pruritus.
Gutierrez Rodrigo A RA Berger Timothy G TG Shah Vinil V Agnihothri Ritesh R Demir-Deviren Sibel S Fassett Marlys S MS
JAMA dermatology 20220901 9
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| S-EPMC7145384 | biostudies-literature
Project description:BackgroundThere are no systematic reviews of corticosteroids for shoulder pain that calculate the numbers needed to treat.AimWe wished to determine the effectiveness in terms of improvement of symptoms of intra-articular and subacromial injections of corticosteroid for rotator cuff tendonitis and frozen shoulder.Design of studySystematic review and meta-analysis of randomised controlled trials.MethodData sources included the Cochrane Controlled Trials Register, Medline, EMBASE, hand searches and author contacts. The review methods required any randomised controlled trial in which the effectiveness of subacromial or intra-articular steroid injections versus placebo and versus non-steroidal anti-inflammatory medication, could be ascertained. The outcome was improvement of symptoms. The data abstraction was done independently, as was the validity assessment. The data was pooled using Review Manager 4.1.ResultsSeven studies were reviewed for corticosteroids versus placebo and three for corticosteroids versus nonsteroidal anti-inflammatory drugs (NSAIDs). The relative risk for improvement for subacromial corticosteroid injection for rotator cuff tendonitis was 3.08 (95% confidence interval [CI] = 1.94 to 4.87). The number needed to treat based on the pooled relative risk was 3.3 (95% CI = 1.8 to 7.7) patients to obtain one improvement. The relative risk for high dose (50 mg of prednisone or more) was 5.9 (95% CI = 2.8 to 12.6). The relative risk for improvement with steroids compared with NSAIDs was 1.43 (95% CI = 0.95 to 2.16). The number needed to treat for corticosteroids versus NSAIDs was 2.5 (95% CI = 1 to 9) for one significant study. The relative risks for intra-articular steroid injection for rotator cuff tendonitis were not statistically significant.ConclusionSubacromial injections of corticosteroids are effective for improvement for rotator cuff tendonitis up to a 9-month period. They are also probably more effective than NSAID medication. Higher doses may be better than lower doses for subacromial corticosteroid injection for rotator cuff tendonitis.
| S-EPMC1463095 | biostudies-literature
Project description:BackgroundThe transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI.MethodsA total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated.ResultsBoth the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm2]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds).ConclusionsESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI.
| S-EPMC5532530 | biostudies-literature
Project description:BackgroundTo estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection.MethodsA systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention).ResultsThe search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting.ConclusionIn this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.
| S-EPMC2945953 | biostudies-literature
Project description:ObjectiveSeasonal allergic rhinitis (SAR) is an exaggerated immunological reaction to allergens (pollen) in the air. In a small subgroup of patients, SAR can be difficult to control with first-line therapy. Intramuscular corticosteroid injections (IMCIs) are an additional treatment in this subgroup of SAR patients. The aim of this systematic review is to investigate the efficacy and safety of IMCIs in SAR.MethodsTitles and abstracts were independently screened, followed by full-text screening based on predefined criteria. Included articles were critically appraised using the Cochrane Risk of Bias 2 (RoB 2) tool. The primary outcome is reported as the final conclusion about efficacy that was stated in the included studies. The secondary outcome is the safety of IMCIs with regard to long lasting side-effects.ResultsThe search yielded 2139 records, of which 10 were relevant and valid for our clinical question. Critical appraisal showed high risk of bias, which was due to unclear description of methods. Four out of four placebo-controlled, randomized controlled trials reported a significant and relevant difference in efficacy in favor of IMCIs compared with placebo. The occurrence of side-effects was not different between IMCIs and placebo or oral corticosteroids (OCs).ConclusionThe outcome of this systematic review on trials concerning intramuscular steroid injections, despite being based on individual studies claiming favorable outcome with their use, is "inconclusive." This is because of the epidemiological high risk of bias in these studies that were mostly executed more than 30 years ago. The "inconclusive" rating allows for a description as an "optional therapy" for severe cases in guideline formation.
| S-EPMC8513445 | biostudies-literature
Project description:ObjectiveTo observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy.MethodsThirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction.ResultsLevels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion.ConclusionIn SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.
| S-EPMC5532346 | biostudies-literature
Project description: Not available
| S-EPMC3052879 | biostudies-literature
Project description:Background: Arthritis involving the thumb carpometacarpal (CMC) joint is common in the adult population. Initial treatment includes corticosteroid injections. Injections can be performed with image guidance to assist with placement; however, the clinical benefits are unclear. Methods: This retrospective study used Truven Health Marketscan Research Databases to identify patients from 2003 to 2014 with common International Classification of Diseases, Ninth Revision (ICD-9) codes for osteoarthritis of the CMC joint, Common Procedural Terminology (CPT) codes for image and non-image-guided injections, and codes for surgical interventions. Length of time from injection until subsequent injection(s) and/or surgery was extrapolated for identified patients. Analysis of variance and binomial logistic regression were used to compare continuous variables and calculate odds ratios, respectively. Results: We identified 62 333 patients (68% women, 32% men), average age 59.7, with common ICD-9 diagnostic codes for CMC arthritis with respective injection CPT codes. The average number of days between the first and second injection for patients treated with non-guided injection was 237.3 versus 266.7 for image-guided injections. Of the 62333 patients, 8107 went on to operative treatment. Among operative patients, the average number of days to surgery following non-guided injection was 317.7 versus 333.7 days in the image-guided group. The average cost of performing non-image-guided injections was $203 less than using ultrasound. Conclusions: Image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery. Future research needs to clarify the value of image-guided CMC injections in an increasingly economically conscientious health care environment.
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Project description:UnlabelledCutaneous atrophy resulting from corticosteroid injections for musculoskeletal indications is an underrecognized adverse effect among orthopedists and dermatologists. We present two cases of cutaneous atrophy following corticosteroid injections for wrist tendonitis. Patients presenting with cutaneous atrophy following orthopedic corticosteroid injections may be misdiagnosed with linear morphea, atrophoderma, or vascular disorders and receive unnecessary workups and delays in appropriate management. Dermatologists play an essential role in the evaluation of these patients.
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