A post-five-year physician follow-up of a predetermined study group of patients who had received lumbar transforaminal epidural steroid injections (TFESI’s) to treat acute unilateral lumbar pain from their single level herniated nucleus found that, although the procedure offered temporary relief, most patients reported needed some type of additional pain intervention (medicinal, another TFESI, or back surgery) when interviewed 5 to 9 years after their procedure.
The 39 patients interviewed in this study were part of an original 78 subjects who had enrolled in a randomized controlled trial, in which the remaining patients were unreachable after multiple attempts five years after their TFESI’s.
During a phone follow-up, 30 of the 39 patients reported having experienced recurring pain since their initial procedure, though only nine reported experiencing pain at the time of the phone call. Three patients were taking opioid medication to relieve their pain. Nine patients reported having had subsequent TFESI procedures since the first, and 19 of the subjects reported having had back surgery since their TFESI. Three patients reported unemployment due to their recurring back pain.
A comparison of the subjects who reported having had surgery to those who had not showed no difference in the rate of recurring or current pain, additional injections, unemployment, or opioid use.
While TFESI ‘s can be an effective means of short-term pain relief for patients with lumbar intervertebral disc herniation radicular pain, most patients interviewed in this study reported the recurrence of symptoms and need subsequent relief treatments—surgical, opioid, or another TFESI—five to nine years after their initial injection. Because there was little difference in the percentage of patients who chose surgery and those who had at least one subsequent TRESI in relation to the rate of pain recurrence, the authors of the study suggest that physicians should discuss and decide upon appropriate pain treatment measures with their patients based upon the frequency and severity of their acute pain, as well as their response history of previous treatments. Radicular pain caused by a herniated disc is a condition that should be treated effectively in its acute stage, though it is likely to remain a recurring health issue that may require multiple treatments over long periods of time. This fact should be considered by the practitioner and patient when deciding on appropriate treatment measures.