Affiliations: [a] Kaiser Permanente Santa Clara Medical Center, Department of Physical Medicine and Rehabilitation, Santa Clara, CA, USA | [b] Division of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Redwood City, CA, USA
Correspondence:
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Address for correspondence: Raj Mitra, M.D., Chief, Physical Medicine and Rehabilitation, Clinical Associate Professor, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA. E-mail: rmitra@stanford.edu
Abstract: Background:Cervical epidural steroid injections (ESIs) are often used to treat patients with neck and upper extremity pain associated with a cervical radiculopathy. The effect of chronic opioid use in cervical radiculopathy patients managed with ESIs is unknown; past studies suggest that these patients may behave differently than opioid naïve patients. The purpose of this study is to determine the effect of chronic (greater than 6 months) opioid use on the immediate outcome of cervical ESIs. Methods:A two year retrospective chart review identified 22 consecutive patients with cervical radiculopathy who underwent a single level interlaminar cervical ESI, main outcome variable was > 50% pain relief on VAS at follow up. Inclusion factors were unilateral disc protrusion, exclusion factors were severe central canal or foraminal stenosis, spondylolithesis, spinal instability, cord edema, or with multi-level disc protrusions. Results:Using a linear logistic regression analysis on both patient demographics and physical exam measures, the most significant explanatory model was the use of opiates at the time of injection; 70% of opioid naïve patients had a favorable outcome while only 20% of patients managed with chronic opioids had relief (p= 0.06). Conclusions:Patients managed with opioids chronically may respond in a different manner to ESIs when compared to opioid naïve patients.
