Эпидуральные блокады с использованием глюкокортикоидов: как насчет принципов доказательной медицины?
https://doi.org/10.14412/1996-7012-2016-3-87-94
Аннотация
Эпидуральные инъекции глюкокортикоидов (ГК), так называемые блокады, часто представляют как очень эффективный и самый современный способ лечения неспецифической боли в спине и люмбоишиалгии. Однако эпидуральное введение лекарственных препаратов (местных анестетиков – МА) для купирования боли в спине практикуется еще с 1901 г., когда его впервые применили французские врачи J. Sicard и F. Cathelin, т. е. относится к самым давним лечебным методикам. При этом мнения экспертов о терапевтической ценности эпидуральных инъекций (ЭИ) ГК достаточно противоречивы. Данные большого числа клинических исследований не подтверждают однозначного преимущества эпидурального введения ГК в комбинации с МА в сравнении с эффектом только МА. Согласно выводам ряда экспертов, эффект ЭИ ГК лишь ненамного превосходит действие плацебо (физиологический раствор) и мало влияет на отдаленные результаты лечения. Эпидуральное введение ГК может приводить к редким, но очень серьезным, угрожающим жизни осложнениям. Очевидно, что этот метод следует использовать, лишь тщательно взвесив его возможную пользу и риск. В любом случае, проведение ЭИ ГК не следует рассматривать в качестве альтернативы другим фармакологическим и нефармакологическим методам терапии.
Об авторе
А. Е. Каратеев
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия 115522, Москва, Каширское шоссе, 34А
Россия
Россия
Литература
1. Яхно НН, Кукушкин МЛ, редакторы. Боль (практическое руководство для врачей). Москва: Издательство РАМН; 2012. 512 c. [Yakhno NN, Kukushkin ML, editors. Bol' (prakticheskoe rukovodstvo dlya vrachei) [Pain (practical guide for physicians)]. Moscow: Izdatel'stvo RAMN; 2012. 512 p.].
2. Gore M, Sadosky A, Stacey B, et al. The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine (Phila Pa 1976). 2012;37(11):668-77.
3. Эрдес ШФ, Фоломеева ОМ. Ревматические заболевания и инвалидность взрослого населения Российской Федерации. Научно-практическая ревматология. 2007;45(4):4-9. [Erdes ShF, Folomeeva OM. Rheumatic diseases and disability of Russian Federation adult population. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2007;45(4):4-9. (In Russ.)]. doi: 10.14412/1995-4484-2007-4-9.
4. Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability- adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015 Nov 28;386(10009):2145-91. doi: 10.1016/S0140-6736(15)61340-X. Epub 2015 Aug 28.
5. Каратеев АЕ. Болезни костно-мышечной системы в практике 2102 врачей разных специальностей: структура патологии и мнение специалистов об эффективности НПВП (предварительные данные эпидемиологического исследования КОРОНА-2). Consilium medicum. 2013;(9):95-100. [Karateev AE. Diseases of the musculoskeletal system in the practice of 2102 doctors of different specialties: structure pathology and expert opinion about the effectiveness of NSAIDs (preliminary data of the KORONA-2 epidemiological study). Consilium medicum. 2013;(9):95-100. (In Russ.)].
6. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 Dec;19(12):2075-94.
7. Roelofs PD, Deyo RA, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000396. doi: 10.1002/14651858.CD000396.pub3.
8. Каратеев АЕ. Ацеклофенак в ревматологии: «золотая середина». Современная ревматология. 2013;7(2):88-94. [Karateev AE. Aceclofenac in rheumatology: The golden mean. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2013;7(2):88-94. (In Russ.)]. doi: 10.14412/1996-7012-2013-2389.
9. Castellsague J, Riera-Guardia N, Calingaert B, et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012;35(12):1127-46.
10. Dooley M, Spencer C, Dunn C. Aceclofenac: a reappraisal of its use in the management of pain and rheumatic disease. Drugs. 2001;61(9):1351-78.
11. Lemmel E, Leeb B, De Bast J, Aslanidis S. Patient and physician satisfaction with aceclofenac: results of the European Observational Cohort Study (experience with aceclofenac for inflammatory pain in daily practice). Aceclofenac is the treatment of choice for patients and physicians in the management of inflammatory pain. Curr Med Res Opin. 2002;18(3):146-53.
12. Legrand E. Aceclofenac in the management of inflammatory pain. Expert opinion on pharmacotherapy. 2004;5(6):1347-57. doi: 10.1517/14656566.5.6.1347.
13. Шарапова ЕП, Таскина ЕА, Раскина ТА и др. Ацеклофенак в терапии остеоартроза. Лечащий врач. 2012;(8):90-4. [Sharapova EP, Taskina EA, Raskina TA, et al. Aceclofenac in the treatment of osteoarthritis. Lechashchii vrach. 2012;(8): 90-4. (In Russ.)].
14. Каратеев АЕ, Денисов ЛН, Маркелова ЕИ и др. Результаты клинического исследования АЭРОПЛАН (анализ эффективности и риска осложнений при лечении артрита ацеклофенаком и нимесулидом). Consilium Medicum. 2013;15(2):48-53. [Karateev AE, Denisov LN, Markelova EI, et al. The results of AEROPLAN clinical study (analysis of the effectiveness and risk of complications in the treatment of arthritis by aceclofenac and nimesulide). Consilium Medicum. 2013;15(2):48-53. (In Russ.)].
15. Шарапова ЕП, Кашеварова НГ, Аникин СГ и др. Применение новых форм ацеклофенака при остеоартрозе в реальной клинической практике. Современная ревматология. 2014;8(1):73-6. [Sharapova EP, Kashevarova NG, Anikin S, et al. The use of new aceclofenac dosage forms in patients with osteoarthrosis in real-life clinical practice. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2014;8(1):73-6. (In Russ.)]. doi: 10.14412/1996-7012-2014-1-73-76.
16. Machado G, Maher C, Ferreira P, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225.
17. Chaparro LE, Furlan AD, Deshpande A, et al. Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976). 2014 Apr 1;39(7):556-63. doi: 10.1097/BRS.0000000000000249.
18. van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev 2003;(2):CD004252.
19. See S, Ginzburg R. Choosing a skeletal muscle relaxant. Am Fam Physician. 2008 Aug 1;78(3):365-70.
20. Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014 Jun;39(6):427-35.
21. Friedman BW, Dym AA, Davitt M, et al. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA. 2015 Oct 20;314(15):1572-80. doi: 10.1001/ jama.2015.13043.
22. Исайкин АИ, Иванова МА. Блокады в лечении поясничных болей: мнение «за». Лечение заболеваний нервной системы. 2016;18(1):29-37. [Isaikin AI, Ivanova MA. Blockade in the treatment of lumbar pain: agree. Lechenie zabolevaniy nervnoy sistemy. 2016;18(1):29-37. (In Russ.)].
23. Igarashi A, Kikuchi S, Konno S, Olmarker K. Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine (Phila Pa 1976). 2004 Oct 1;29(19):2091-5.
24. Genevay S, Finckh A, Payer M, et al. Elevated levels of tumor necrosis factor-alpha in periradicular fat tissue in patients with radiculopathy from herniated disc. Spine (Phila Pa 1976). 2008 Sep 1;33(19):2041-6. doi: 10.1097/BRS.0b013e318183bb86.
25. Cuellar JM, Golish SR, Reuter MW, et al. Cytokine evaluation in individuals with low back pain using discographic lavage. Spine J. 2010 Mar;10(3):212-8. doi: 10.1016/j.spinee. 2009.12.007.
26. Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine (Phila Pa 1976). 2007 Jul 15;32(16):1754-60.
27. Ter Meulena B, Weinsteina H, Ostelob R, Koehlerd P. The Epidural Treatment of Sciatica: Its Origin and Evolution Eur Neurol. 2016;75(1-2):58-64. doi: 10.1159/ 000443729. Epub 2016 Jan 28.
28. Luhmann H. Treatment of ischialgia and lumbago with epidural injections. Med Klin. 1954 Dec 17;49(51):2039-40.
29. Sharma PK. Indications, technique and results of caudal epidural injection for lumbar disc retropulsion. Postgrad Med J. 1977 Jan;53(615):1-6.
30. Kaye A, Manchikanti L, Abdi S, et al. Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain Physician. 2015 Nov;18(6):E939-1004.
31. Chou R, Hashimoto R, Friedly J, et al. Pain Management Injection Therapies for Low Back Pain [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Mar. AHRQ Technology Assessments.
32. Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012 Dec 18;157(12):865-77.
33. Staal JB, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2009 Jan 1;34(1): 49-59.
34. Arden NK, Price C, Reading I, et al. A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology (Oxford). 2005 Nov;44(11):1399-406. Epub 2005 Jul 19.
35. Zarghooni K, Rashidi A, Siewe J, et al. Single-Shot Epidural Injections in the Management of Radicular Pain. Orthop Rev (Pavia). 2015 Dec 28;7(4):5985. doi: 10.4081/or.2015.5985. eCollection 2015.
36. Leung SM, Chau WW, Law SW, Fung KY. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J. 2015 Oct;21(5):394-400. doi: 10.12809/ hkmj144310. Epub 2015 Aug 14.
37. Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the «control» injections in randomized controlled trials. Anesthesiology. 2013 Oct;119(4):907-31. doi: 10.1097/ ALN.0b013e31829c2ddd.
38. Manchikanti L, Knezevic NN, Boswell MV, et al. Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta- Analysis. Pain Physician. 2016 Mar;19(3):E365-410.
39. Manchikanti L, Cash KA, Pampati V, Falco FJ. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician. 2014 Jul-Aug;17(4):E489-501.
40. ökmen K, Metin ökmen B. The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain; a randomized, blinded, prospective study. Spine J. 2016 Aug 20. pii: S1529-9430(16)30886-5. doi: 10.1016/j.spinee.2016.08.024. [Epub ahead of print].
41. Pountos I, Panteli M, Walters G, et al. Safety of Epidural Corticosteroid Injections. Drugs R D. 2016 Mar;16(1):19-34. doi: 10.1007/s40268-015-0119-3.
42. Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med. 2006 Jan-Feb;7(1):52-6.
43. Gö tz F, Lanfermann H, Becker H. Cervical epidural abscess following lumbar epidural steroid injections. Klin Neuroradiol. 2009 Aug;19(3):220-6.
44. Simopoulos TT, Kraemer JJ, Glazer P, Bajwa ZH. Vertebral osteomyelitis: a potentially catastrophic outcome after lumbar epidural steroid injection. Pain Physician. 2008 Sep- Oct;11(5):693-7.
45. Yue WM, Tan SB. Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections. Spine (Phila Pa 1976). 2003 Jun 1;28(11):E209-11.
46. Hoelzer BC, Weingarten TN, Hooten WM, et al. Paraspinal abscess complicated by endocarditis following a facet joint injection. Eur J Pain. 2008 Apr;12(3):261-5.
47. Hooten W, Mizerak A, Carns PE, Huntoon MA. Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature. Pain Med. 2006 Jan-Feb;7(1):46-51.
48. Kim SY, Han SH, Jung MW, Hong JH. Generalized infection following facet joint injection. A case report. Korean J Anesthesiol. 2010 Apr;58(4):401-4. doi: 10.4097/kjae. 2010.58.4.401. Epub 2010 Apr 26.
49. Patel A, Alton T, Bransford R, et al. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014 Feb 1;14(2):326-30. doi: 10.1016/j.spinee. 2013.10.046. Epub 2013 Nov 12.
50. Fitzgibbon D, Posner K, Domino K, et al. Chronic pain management: American Society of Anesthesiologists Closed Claims Project. Anesthesiology. 2004 Jan;100(1):98-105.
51. Manchikanti L, Hirsch JA. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep. 2015 May;19(5):482. doi: 10.1007/s11916-015- 0482-3.
52. Plastaras C, McCormick Z, Garvan C, et al. Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J. 2015 Oct 1;15(10):2157-65. doi: 10.1016/j.spinee. 2015.05.034. Epub 2015 Jun 9.
53. Rathmell JP, Michna E, Fitzgibbon DR, et al. Injury and liability associated with cervical procedures for chronic pain. Anesthesiology. 2011;114(4):918-26.
54. Popescu A, Lai D, Lu A, Gardner K. Stroke following epidural injections-case report and review of literature. J Neuroimaging. 2013 Jan;23(1):118-21. doi: 10.1111/j.1552- 6569.2011.00615.x. Epub 2011 Jun 23.
55. Scanlon G, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine (Phila Pa 1976). 2007 May 15;32(11):1249-56.
56. Abdele Rahman K, Rakocevic G. Paraplegia following lumbosacral steroid epidural injections. J Clin Anesth. 2014 Sep;26(6):497-9. doi: 10.1016/j.jclinane. 2014.03.010. Epub 2014 Sep 4.
57. Thefenne L, Dubecq C, Zing E, et al. A rare case of paraplegia complicating a lumbar epidural infiltration. Ann Phys Rehabil Med. 2010 Nov;53(9):575-83. doi: 10.1016/j.rehab.2010.08.029. Epub 2010 Sep 21.
58. Kennedy D, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med. 2009 Nov;10(8):1389-94. doi: 10.1111/j.1526-4637.2009.00728.x. Epub 2009 Oct 26.
59. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002 Jan-Feb;2(1):70-5.
60. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. http://www.fda.gov/Drugs/DrugSafety/ucm3 94280.htm.
61. Boggs W. Spinal injections of steroids temporarily ease low back pain. http://www.reuters.com/article/us-healthbackache- steroidsidUSKCN0QT2CX20150824.
Рецензия
Для цитирования:
Каратеев А.Е. Эпидуральные блокады с использованием глюкокортикоидов: как насчет принципов доказательной медицины? Современная ревматология. 2016;10(3):87-94. https://doi.org/10.14412/1996-7012-2016-3-87-94
For citation:
Karateev A.E. Epidural blockades using glucocorticoids: As to how the principles of evidence-based medicine? Modern Rheumatology Journal. 2016;10(3):87-94. (In Russ.) https://doi.org/10.14412/1996-7012-2016-3-87-94
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