CERVICAL EPIDURAL STEROID INJECTION FOR CERVICOBRACHIALGIA

Fifty patients with chronic resistant cervicobrachialgia were randomly divided into two groups. Twenty-five patients (group A) were treated with cervical epidural steroid/lidocaine injections and 17 patients (g roup B) were treated with steroid/Lidocaine injections into the poster ior neck muscles. Another eight patients from group B were excluded fr om the study because they had started the process of litigation of ins urance claims and their subjective analysis of pain relief might there fore not be trustworthy. One to three injections were administered at 2-week intervals according to the clinical response. All patients cont inued their various pre-study treatments: non-steroidal anti-inflammat ory drugs, non-opioid analgesics and physiotherapy. Pain relief was ev aluated by the visual analogue scale 1 week after the last injection a nd then 1 year later. One week after the last injection we rated pain relief as very good and good in 76% of the patients in group A, as com pared to 35.5% of the patients in group B. One year after the treatmen t 68% of the group A patients still had very good and good pain relief , whereas only 11.8% of group B patients reported this degree of pain relief These differences were statistically significant. We failed to achieve significant improvement of tendon reflexes or of sensory loss in both groups, but the increase in the range of motion, the fraction of patients who were able to decrease their daily dose of analgesics, and recovery of the capacity for work were significantly better in gro up A. We encountered no complications in either group of patients. We conclude that cervical epidural steroid/local anaesthetic injection is an effective method for achieving immediate and long-standing pain re lief and improvement in motion and performance in chronic resistant ce rvicobrachialgia.