Chemonucleolysis With Radiopaque Gelified Ethanol May Be Effective Analgesic for Chronic Radicular Pain

The use of percutaneous chemonucleolysis with radiopaque gelified ethanol may be safe and effective for patients with chronic radicular leg pain that is resistant to conservative treatment, according to an observational open-label study published in Pain Medicine.

Patients with treatment-resistant chronic radicular leg pain were asked to report pain levels using the 10-point verbal numeric scale (VNS) and the Roland-Morris low back pain and disability questionnaire (RMQ) prior to and up to 30 months after radiopaque gelified ethanol application.

Achievement of clinically significant functional improvement — assessed with the RMQ and VNS — occurred in 20 and 19 of 29 patients at the first follow-up (0-6 months); 20 of 29 and 19 of 27 patients, respectively, at the 6- to 12-month follow-up; 9 of 12 patients with both methods at the 12- to 18-month follow-up; 8 of 9 patients at 18 to 24 months for both; and 4 of 4 patients at the 24- to 30-month follow-up for both.

Because of the study’s small sample size, open-label design, and absence of a control group, the conclusive efficacy of the gelified ethanol approach in chronic leg pain cannot be asserted.

Although 4 of the patients in this study experienced worsened conditions following the gelified ethanol application, the investigators suggest, “that this aggravation is due to the natural course of the disease rather than the negative effect of the intradiscal application of gelified ethanol itself.”

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Houra K, Perovic D, Rados I, Kvesic D. Radiopaque gelified ethanol application in lumbar intervertebral soft disc herniations: Croatian multicentric study. Pain Med [published online October 28, 2017]. doi: 10.1093/pm/pnx270