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Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review.

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Title: Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review.
Author(s): Manchikanti, L.; Nampiaparampil, D.E.; Candido, K.D.; Bakshi, S.; Grider, J.S.; Falco, F.J.E.; Sehgal, N.; Hirsch, J.A.
Subject(s): Chronic neck pain cervical disc herniation cervical spinal stenosis cervical post surgery syndrome cervical discogenic pain cervical epidural injections
Abstract: BACKGROUND: The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. OBJECTIVES: To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. METHODS: The literature search was performed from 1966 to October 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references. The evidence was assessed based on best evidence synthesis with Level I to Level V. RESULTS: There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these injections for managing central spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. There were 4 high quality manuscripts. A qualitative synthesis of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections. LIMITATIONS: Paucity of available literature, specifically conditions other than disc herniation. CONCLUSION: This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome.
Issue Date: 2015-01
Publisher: American Society of Interventional Pain Physicians
Citation Info: Manchikanti, L., Nampiaparampil, D. E., Candido, K. D., Bakshi, S., Grider, J. S., Falco, F. J. E., Sehgal, N. and Hirsch, J. A. Do Cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Physician. 2015. 18(1): 39-60.
Type: Article
Description: This is the copy of an article published in Pain Physician © 2015 American Society of Interventional Pain Physicians Publications. Pain Physician. 2015. 18(1): 39-60.
URI: http://hdl.handle.net/10027/19454
ISSN: 1533-3159
Date Available in INDIGO: 2015-06-03
 

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