Analgesic Discography: Effect of Adding a Local Anesthetic to Routine Lumbar Provocation Discography

Richard Derby, Jeong Eun Lee, Sang Heon Lee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs. Objective: We anticipated and sought to confirm that injecting local anesthetic in intervertebral discs would provide convincing pain relief and that the degree of pain relief would help confirm or refute the findings of provocative discography. Methods: There were 23 patients in the nonanalgesic group, and 47 patients in the analgesic group. The analgesic patient discs were injected with an equal volume of local anesthetic and nonionic contrast media. Lumbar discography was performed using an automated pressure-controlled provocative discographic (APCPD) technique. Subjects reported global subjective relief at 15 and 45 minutes after APCPD. Pre- and post-procedure pain was rated using a numerical rating scale (NRS) using standardized pain provoking positions. In addition, we further compared the numbers of patients reporting a decrease in NRS scores (≥2) in standardized pain provoking positions. Results: The addition of local anesthetic to APCPD did not affect the number of positive APCPD results that averaged ∼30% positive discs in both groups. The addition of local anesthetic to contrast significantly reduced pain NRS scores by 2/10 or greater during forward flexion and sitting compared with patients whose discs were injected with contrast without local anesthetic. The average pain improvement using standardized pain provocation positions and average subjective relief were not, however, significantly different in the two groups. Only two patients reported overall pain relief equal or greater to 50%. Conclusions: Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort. Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)1335-1342
Number of pages8
JournalPain Medicine
Volume11
Issue number9
DOIs
Publication statusPublished - 2010 Jan 1

Fingerprint

Local Anesthetics
Analgesics
Pain
Pressure
Intervertebral Disc
Contrast Media

Keywords

  • Analgesia
  • Analgesic Discography
  • Analgesic Diskography
  • Back Pain
  • Disc Block
  • Discography
  • Diskography
  • Intervertebral Disc
  • Local Anesthesia
  • Local anesthetic

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Analgesic Discography : Effect of Adding a Local Anesthetic to Routine Lumbar Provocation Discography. / Derby, Richard; Lee, Jeong Eun; Lee, Sang Heon.

In: Pain Medicine, Vol. 11, No. 9, 01.01.2010, p. 1335-1342.

Research output: Contribution to journalArticle

@article{7fa9fa1e51914160a758cf07e17e80c7,
title = "Analgesic Discography: Effect of Adding a Local Anesthetic to Routine Lumbar Provocation Discography",
abstract = "Introduction: There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs. Objective: We anticipated and sought to confirm that injecting local anesthetic in intervertebral discs would provide convincing pain relief and that the degree of pain relief would help confirm or refute the findings of provocative discography. Methods: There were 23 patients in the nonanalgesic group, and 47 patients in the analgesic group. The analgesic patient discs were injected with an equal volume of local anesthetic and nonionic contrast media. Lumbar discography was performed using an automated pressure-controlled provocative discographic (APCPD) technique. Subjects reported global subjective relief at 15 and 45 minutes after APCPD. Pre- and post-procedure pain was rated using a numerical rating scale (NRS) using standardized pain provoking positions. In addition, we further compared the numbers of patients reporting a decrease in NRS scores (≥2) in standardized pain provoking positions. Results: The addition of local anesthetic to APCPD did not affect the number of positive APCPD results that averaged ∼30{\%} positive discs in both groups. The addition of local anesthetic to contrast significantly reduced pain NRS scores by 2/10 or greater during forward flexion and sitting compared with patients whose discs were injected with contrast without local anesthetic. The average pain improvement using standardized pain provocation positions and average subjective relief were not, however, significantly different in the two groups. Only two patients reported overall pain relief equal or greater to 50{\%}. Conclusions: Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort. Wiley Periodicals, Inc.",
keywords = "Analgesia, Analgesic Discography, Analgesic Diskography, Back Pain, Disc Block, Discography, Diskography, Intervertebral Disc, Local Anesthesia, Local anesthetic",
author = "Richard Derby and Lee, {Jeong Eun} and Lee, {Sang Heon}",
year = "2010",
month = "1",
day = "1",
doi = "10.1111/j.1526-4637.2010.00930.x",
language = "English",
volume = "11",
pages = "1335--1342",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Analgesic Discography

T2 - Effect of Adding a Local Anesthetic to Routine Lumbar Provocation Discography

AU - Derby, Richard

AU - Lee, Jeong Eun

AU - Lee, Sang Heon

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Introduction: There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs. Objective: We anticipated and sought to confirm that injecting local anesthetic in intervertebral discs would provide convincing pain relief and that the degree of pain relief would help confirm or refute the findings of provocative discography. Methods: There were 23 patients in the nonanalgesic group, and 47 patients in the analgesic group. The analgesic patient discs were injected with an equal volume of local anesthetic and nonionic contrast media. Lumbar discography was performed using an automated pressure-controlled provocative discographic (APCPD) technique. Subjects reported global subjective relief at 15 and 45 minutes after APCPD. Pre- and post-procedure pain was rated using a numerical rating scale (NRS) using standardized pain provoking positions. In addition, we further compared the numbers of patients reporting a decrease in NRS scores (≥2) in standardized pain provoking positions. Results: The addition of local anesthetic to APCPD did not affect the number of positive APCPD results that averaged ∼30% positive discs in both groups. The addition of local anesthetic to contrast significantly reduced pain NRS scores by 2/10 or greater during forward flexion and sitting compared with patients whose discs were injected with contrast without local anesthetic. The average pain improvement using standardized pain provocation positions and average subjective relief were not, however, significantly different in the two groups. Only two patients reported overall pain relief equal or greater to 50%. Conclusions: Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort. Wiley Periodicals, Inc.

AB - Introduction: There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs. Objective: We anticipated and sought to confirm that injecting local anesthetic in intervertebral discs would provide convincing pain relief and that the degree of pain relief would help confirm or refute the findings of provocative discography. Methods: There were 23 patients in the nonanalgesic group, and 47 patients in the analgesic group. The analgesic patient discs were injected with an equal volume of local anesthetic and nonionic contrast media. Lumbar discography was performed using an automated pressure-controlled provocative discographic (APCPD) technique. Subjects reported global subjective relief at 15 and 45 minutes after APCPD. Pre- and post-procedure pain was rated using a numerical rating scale (NRS) using standardized pain provoking positions. In addition, we further compared the numbers of patients reporting a decrease in NRS scores (≥2) in standardized pain provoking positions. Results: The addition of local anesthetic to APCPD did not affect the number of positive APCPD results that averaged ∼30% positive discs in both groups. The addition of local anesthetic to contrast significantly reduced pain NRS scores by 2/10 or greater during forward flexion and sitting compared with patients whose discs were injected with contrast without local anesthetic. The average pain improvement using standardized pain provocation positions and average subjective relief were not, however, significantly different in the two groups. Only two patients reported overall pain relief equal or greater to 50%. Conclusions: Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort. Wiley Periodicals, Inc.

KW - Analgesia

KW - Analgesic Discography

KW - Analgesic Diskography

KW - Back Pain

KW - Disc Block

KW - Discography

KW - Diskography

KW - Intervertebral Disc

KW - Local Anesthesia

KW - Local anesthetic

UR - http://www.scopus.com/inward/record.url?scp=77956542739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956542739&partnerID=8YFLogxK

U2 - 10.1111/j.1526-4637.2010.00930.x

DO - 10.1111/j.1526-4637.2010.00930.x

M3 - Article

C2 - 20735752

AN - SCOPUS:77956542739

VL - 11

SP - 1335

EP - 1342

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 9

ER -