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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 April;79(4):370-8
Long-lasting beneficial effects of periradicular injection of meloxicam for treating chronic low back pain and sciatica
Borghi B. 1, Aurini L. 1, White P. F. 1, 3, Mordenti A. 1, Lolli F. 4, Borghi R. 1, Martignani M. 1, Greggi T. 4 ✉
1 Department of Biomedical and Neuromotor Sciences, University of Bologna, Research Unit of Anesthesia and Intensive Care, Rizzoli Orthopedic Institute, Bologna, Italy;
2 Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA;
3 Department of Anesthesiology, White Mountain Institute, Los Altos, CA, USA;
4 Spine Deforming Surgey Division, Rizzoli Orthopedic Institute, Bologna, Italy
Background: Chronic low back pain (LBP) and sciatica can occur without obvious structural causes and are often resistant to conventional analgesic drugs. The effect of periradicular injection of meloxicam on LBP with or without a radicular component was assessed. A secondary objective of this prospective observational study was to assess the effect of meloxicam on functional recovery.
Methods: Seventy-two patients (30 men, 42 women) with LBP and/or sciatica were followed for 90 days to six years after injecting 10 mg meloxicam in 10 mL saline at each of the involved dermatomal levels. A standard verbal rating scale (VRS) from 0=no pain to 10=severe pain was used for assessing LBP before the injection of meloxicam (at baseline) and at 1, 5, 10, 30 and 60 min, and 1, 5, 15, 30 and 90 days intervals after the injection. The meloxicam injection was repeated only if the VRS score remained >3. Rescue analgesic requirements and functional activity levels were also assessed from 30-90 days after the last injection of meloxicam.
Results: The mean baseline LBP score was 8.60±1.50 (SD) despite the use of multi-modal analgesic regimens (NSAIDs, glucocorticosteroids, paracetamol, oral opioids, gabapentanoid compounds, epidural or periradicular steroid and/or local anesthetics) as well as laser treatments and physical therapy. The majority of patients reported that their pain intensity decreased by ~50% 1-2 min after the meloxicam injection was completed. Thirty-six patients (50%) required no further injections, 25 patients (35%) required a second injection after seven days, and 11 patients (15%) required a total of three injections. After the meloxicam treatment(s), only 10 patients (14%) required “rescue” analgesia with oral NSAIDs. All patients were able to increase their level of functional activity after the meloxicam treatment(s).
Conclusion: Periradicular injections of meloxicam (10 mg) appear to be a useful alternative to opioid and non-opiod analgesics for patients with intractable LBP due to nerve root inflammation.