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Shim, Kim, Song, Kim, Kwon, and Jeon: The Usefulness of Selective Spinal Nerve Root Block in Neuropathic Pain Patients with Radiculopathy
Original Article

Journal of the Korean Orthopaedic Association 2015; 50(2): 116-123.

Published online: 30 April 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.2.116

The Usefulness of Selective Spinal Nerve Root Block in Neuropathic Pain Patients with Radiculopathy

Dae Moo Shim, M.D., Tae Kun Kim, M.D., Seung Yeop Song, M.D., Chang Su Kim, M.D.*, Byung Taek Kwon, M.D., Young Dae Jeon, M.D.*

Department of Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

*Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.

Correspondence to: Chang Su Kim, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea. TEL: +82-51-990-6467, FAX: +82-51-243-0181, mewha98@naver.com

Received 15 July 2014       Revised 5 November 2014       Accepted 6 January 2015

Copyright © 2015 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted in order to evaluate effect and efficiency of selective spinal nerve root block for neuropathic pain patients with lower leg radiating pain.

Materials and Methods

A total of 113 patients were evaluated and follow-up periods were a minimum of 12 months. They were divided into two groups: group A included 41 patients with neuropathic pain and group B included 72 patients with simple lower leg radiating pain.

Results

Fourteen (34.1%) patients in group A and 45 (62.5%) patients in group B had favorable results for selective spinal nerve block (p<0.05). Visual analog scale (VAS) was improved from 7.57 to 5.23 at 12 months in group A and from 7.11 to 3.49 at 12 months in group B.

Conclusion

The initial treatment period for group A was significantly later than in group B. For patients with neuropathic pain and radiculopathy, early assessment was recommended and early selective spinal nerve block could be a good treatment option for neuropathic pain patients.

Keywords: leg radiating pain, neuropathic pain, selective nerve root block

Figures and Tables

Figure 1

Self-report of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) score in Korean.

jkoa-50-116-g001
Table 1

Treede et al.6)'s Grading System for Neuropathic Pain

jkoa-50-116-i001

Grading of certainty for the presence of neuropathic pain: definite neuropathic pain: all (1 to 4); probable neuropathic pain: 1 and 2, plus either 3 or 4; possible neuropathic pain: 1 and 2, without confirmatory evidence from 3 or 4. *A region corresponding to a peripheral innervation territory or to the topographic representation of a body part in the central nervous system. †The suspected lesion or disease is reported to be associated with pain, including a temporal relationship typical for the condition. ‡As part of the neurologic examination, these tests confirm the presence of negative or positive neurologic signs concordant with the distribution of pain. Clinical sensory examination may be supplemented by laboratory and objective tests to uncover subclinical abnormalities. §As part of the neurologic examination, these tests confirm the diagnosis of the suspected lesion or disease. These confirmatory tests depend on which lesion or disease is causing neuropathic pain.

Table 2

Characteristics of 113 Patients with Selective Nerve Root Block

jkoa-50-116-i002

Values are presented as number only, mean±standard deviation, or mean value of data.

Table 3

Treede Grade and S-LANSS in the Neuropathic Pain Group

jkoa-50-116-i003

S-LANSS, self-report of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale.

Table 4

Comparison of Visual Analogue Scale at Baseline and after Selective Nerve Root Block

jkoa-50-116-i004

Values are presented as mean±standard deviation.

p-value < 0.05.

Notes

This paper was supported by Wonkwang University in 2013.

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Merskey H, Bogduk N. Classification of chronic pain. Description of chrnoic pain syndromes and definitions of pain terms. Seattle: IASP Press;1994. p. 181–182.
2. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain. 1999; 83:389–400.
3. Dworkin RH, O'Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007; 132:237–251.
4. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007; 132:179–188.
5. Taylor RS. Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom Manage. 2006; 31:S13–S19.
6. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008; 70:1630–1635.
7. Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005; 6:149–158.
8. Choi SJ, Song JS, Kim C, et al. The use of magnetic resonance imaging to predict the clinical outcome of non-surgical treatment for lumbar intervertebral disc herniation. Korean J Radiol. 2007; 8:156–163.
9. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am. 2001; 39:31–53.
10. Willén J, Danielson B, Gaulitz A, Niklason T, Schönström N, Hansson T. Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976). 1997; 22:2968–2976.
11. Ciric I, Mikhael MA, Tarkington JA, Vick NA. The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg. 1980; 53:433–443.
12. Wildermuth S, Zanetti M, Duewell S, et al. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology. 1998; 207:391–398.
13. Hansson P. Neuropathic pain: clinical characteristics and diagnostic workup. Eur J Pain. 2002; 6:Suppl A. 47–50.
14. Max MB. Clarifying the definition of neuropathic pain. Pain. 2002; 96:406–407.
15. Jensen TS, Sindrup SR, Bach FW. Test the classification of pain: reply to Mitchell Max. Pain. 2002; 96:407–408.
16. Backonja MM. Defining neuropathic pain. Anesth Analg. 2003; 97:785–790.
17. Cannon WB, Rosenblueth A. The supersensitivity of denervated structures. New York: The Macmillan Company;1949. p. 1–22.
18. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001; 92:147–157.
19. Chung KJ, Lee JH, Hwang C, Ahn MW. A treatment guideline for neuropathic pain. J Korean Soc Spine Surg. 2011; 18:246–253.
20. Irving GA. Contemporary assessment and management of neuropathic pain. Neurology. 2005; 64:S21–S27.
21. Cho SY, Choi BO. Pharmacological treatments of pain. Headache. 2008; 9:13–20.
22. Rasmussen PV, Sindrup SH, Jensen TS, Bach FW. Therapeutic outcome in neuropathic pain: relationship to evidence of nervous system lesion. Eur J Neurol. 2004; 11:545–553.
23. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971; 53:891–903.
24. Goebert HW Jr, Jallo SJ, Gardner WJ, Wasmuth CE, Bitte EM. Sciatica: treatment with epidural injections of procaine and hydrocortisone. Cleve Clin Q. 1960; 27:191–197.
25. Herron LD. Selective nerve root block in patient selection for lumbar surgery: surgical results. J Spinal Disord. 1989; 2:75–79.
26. Lee SJ, Shim DM, Kim TK, Lee SI. Effectiveness of selective nerve root block for the treatment of radiculopathy in degenerative lumbar scoliosis. J Korean Soc Spine Surg. 2012; 19:52–58.
27. Shim DM, Kim TK, Oh SK, Choi YH, Lee SJ. Effectiveness of selective nerve root block on the need for surgical treatment of lumbar spine: a minimum 5 years follow up. J Korean Orthop Assoc. 2009; 44:118–122.
28. Shim DM, Park JY, Yang JH, Choi BS. Effectiveness of selective nerve root block on the need for surgical treatment of lumbar disc herniation. J Korean Orthop Assoc. 2008; 43:413–419.
29. Smith TE, Chong MS. Neuropathic pain. Hosp Med. 2000; 61:760–766.
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