Ketamine Superior to Clonidine as an Adjunct to Epidural Steroid Injections for Low Back Pain

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Patients with complaints of chronic low back pain for ≥3 months, with or without radiculitis, and for whom conventional therapy offered no relief were enrolled in this study.
Patients with complaints of chronic low back pain for ≥3 months, with or without radiculitis, and for whom conventional therapy offered no relief were enrolled in this study.

The following article is part of conference coverage from the IASP 2018 conference in Boston, Massachusetts. Clinical Pain Advisor's staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from IASP 2018.

Ketamine may be superior to clonidine as an adjunct to epidural steroid injection of triamcinolone for patients with chronic low back pain, according to a study to be presented at the 17th World Congress on Pain, held September 12-16, in Boston, Massachusetts.

Although epidural injection of both clonidine and ketamine has been used successfully for the treatment of several chronic pain conditions, their use for chronic low back pain has not been studied extensively.

A total of 40 patients (age 18-70 years) with complaints of chronic low back pain for ≥3 months, with or without radiculitis, and for whom conventional therapy offered no relief were enrolled in this prospective single-blinded pilot study. Patients were randomly assigned to receive epidural triamcinolone 40 mg (in a 0.25% bupivacaine 6 mL solution) in combination with ketamine 50 mg (n=20) or clonidine 75 µg (n=20). Primary efficacy outcomes were improvements from baseline at 15, 30, 60, and 90 days in pain intensity (evaluated with a 0-100 visual analog scale [VAS]), number of additional blocks required, and duration of pain-free period.

Participants in both groups reported reductions in VAS scores from baseline at 90 days (ketamine: 79.5 at baseline to 21.5 at 90 days; clonidine: 81.5 at baseline to 21.5 at 90 days; P <.05 for both). Reductions in VAS scores were comparable between the 2 groups. Participants receiving ketamine vs clonidine reported a longer mean pain-free duration (85.5 days vs 60.75 days, respectively; P <.05). A repeat block was needed in 4 vs 11 patients who had received ketamine vs clonidine, respectively (P <.05), with a second repeat block required by 1 vs 4 patients, respectively.

Despite comparable VAS score reduction between the 2 groups, ketamine had the added benefit of prolonging the analgesic effect and being associated with fewer repeat blocks needed.

For more coverage of IASP 2018, click here.

Reference

Gupta R, Kaur T. To compare efficacy of epidural ketamine vs clonidine as an adjunct to triamcinolone for chronic low backache: a pilot study. Presented at: World Congress on Pain 2018; September 12-16, 2018; Boston, MA. Poster 64056.

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