Transforaminal Epidural Clonidine Versus Corticosteroid for Acute Lumbosacral Radiculopathy Due to Intervertebral Disc Herniation
Burgher AH, Hoelzer BC, Schroeder DR, Wilson GA, Huntoon MA
Spine. 2011;36:E293-300
Article Summary
Use of traditional epidural steroid injections (ESI) is limited due to the potential for adverse side effects associated with corticosteroids. Clonidine, an analgesic and anti-inflammatory agent, has been utilized to manage cancer pain and perioperative pain. Dr. Bugher and colleagues studied 26 patients who underwent up to 3 lumbar transforaminal ESIs with 2% lidocaine and either triamcinolone (40 mg) or clonidine (200 or 400 µg) in this randomized, double blinded study of acute lumbar radicular pain treatment. Both groups showed statistically significant improvement at 2 weeks and at 1 month post-enrollment, but the steroid group noted greater improvement on the RMDQ and ODI scales at 1 month. There were no significant differences in Pain Inventory-NRS, Patient Global Impression of Change, Multidimensional Pain Inventory, Center for Epidemiologic Studies Depression scales or in the number of injections or rate of surgery. However, because the study was noted to be underpowered, the findings of this study are limited.
Viewpoint
While the findings of this article are not able to be generalized due to study limitations, including being underpowered, this study presents an interesting alternative medication to use either in addition to or in place of corticosteroids during lumbar ESIs to treat lumbar radicular pain. Clonidine's safety profile has also been established as well, as it has already been used via epidural and intrathecal routes. Longer-term studies with greater statistical power and with comparison of clonidine vs corticosteroid, as well as placebo, can help further define any potential benefits of this medication in treating lumbar radicular pain.
Abstract